A group of thirty mothers had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were actively in labor.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “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 among the worst examples in the protracted internal conflict tearing the African nation apart. Militiamen stormed the facility, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have called it “an act of unspeakable brutality,” and a stark illustration of the collapse in safety for civilians trapped in war-torn areas in several nations at war.
A Record of Violence Against Maternal Care
While all major powers are signatories to the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of attacks on healthcare systems. Mothers in labor are highly exposed due to their reliance on locally available medical care.
Data analysis and investigations reveal an shocking trend: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.
“These are 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 expectant mothers are stranded.
Deaths have occurred, blocked from reaching help, or forced to give birth in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 kidnapped, and 101 arrested—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
The numbers are probably a significant underestimate, as they are limited to incidents reported in news outlets. In many areas of fighting, information is scarce.
Last year, findings indicated that 50% of women who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.
Beyond killing women and staff, these attacks are destroying hospitals and wards, posing a long-term threat to demographic stability.
Conditions within Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as part of the basis for accusations of genocidal acts.
Even after ceasefires, doctors report that women and children continue to die from a lack of proper treatment, owing to critical shortages of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals could not be reached.
“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has denied 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. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to maternal health issues.
“Russia is targeting us deliberately,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” states a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”
Accountability Evaporates
For the more than 676 million women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.
This absence of consequences has created a “culture of impunity,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially acts of genocide by destroying a group's future.”
Other Conflict Zones
In El Fasher, the area had been cut off 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 scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths 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, resulting in risky home births without skilled assistance.
“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a means of intimidation and to tear apart the social fabric,” notes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘harmful to the enemy’, which has increasingly been used as a justification.”
