Dozens of women were seeking shelter in a childbirth facility in El Fasher, Sudan, as the slaughter began. 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, managed to survive the ordeal. “I heard the screams of women and children,” he states. “They were killing everyone inside the hospital. Those who could run, fled.”
This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the African nation apart. Combatants forced their way into the building, allegedly slaughtering more than 460 patients and their companions.
Rights organizations have called it “an act of unspeakable brutality,” and a stark illustration of the vanishing safeguards for civilians trapped in war-torn areas in several nations at war.
A Record of Violence On Childbirth Services
Although world powers have signed the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Women undergoing childbirth are exceptionally vulnerable due to their reliance on locally available medical care.
An investigation of records show an alarming level of violence: 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 natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these incidents have happened 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 dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 kidnapped, and 101 taken into custody—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
The numbers are probably a significant underestimate, as they capture solely incidents reported in news outlets. In many war-torn areas, reporting is limited.
Last year, findings indicated that one in two mothers who lost their lives in maternal circumstances resided in a war zone. This underscores a horrifying trend.
In addition to the loss of life, these attacks are obliterating maternal and neonatal care facilities, jeopardizing the future to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as one reason behind genocide allegations.
Despite periods of calm, doctors report that women and children are still perishing from inadequate care, owing to critical shortages of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were out of reach.
“We’ve had rockets hitting 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 seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to maternal health issues.
“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”
A Culture of Impunity
For the more than 676 million women living close to deadly warfare, 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,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially acts of genocide by hindering reproduction.”
Additional Hotspots
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 lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.
In Myanmar, hospitals have come under fire and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The End of Safe Deliveries
The majority of childbirth fatalities are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“The deliberate attack on maternity wards indicates a wider and more disturbing trend: the use of attacks on medical facilities 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 are not inviolable if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”
