Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he explains. “They executed everybody 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. Militiamen forced their way into the building, leaving dead more than 460 patients and their companions.
Rights organizations have labeled it “an unspeakable atrocity,” and a stark illustration of the deteriorating protection for civilians living amidst warfare in multiple global hotspots.
A Record of Violence Against Maternal Care
Although world powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has experienced a historic high of violence targeting health services. Mothers in labor are exceptionally vulnerable due to their need for locally available medical care.
An investigation of records show an shocking trend: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These incidents do not represent inevitable outcomes of conflict. They form a pattern of reproductive violence.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.
Mothers have lost their lives, prevented from accessing care, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 kidnapped, and 101 arrested—sometimes in the act of delivering babies.
A Worldwide Emergency in Maternal Health
These figures likely represent a substantial underreporting, as they are limited to incidents covered by the media. In many conflict zones, information is scarce.
Last year, findings indicated that 50% of women who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, creating a grave danger to demographic stability.
Conditions within Gaza
In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as part of the basis for declaring certain actions a genocide.
Even after ceasefires, doctors report that women and children are still perishing from inadequate care, owing to severe deficits of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.
“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” says 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 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 problems during delivery.
“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”
Accountability Evaporates
For the over half a billion females living close to deadly warfare, there are few safeguards and even fewer war crimes prosecutions for those attacking childbirth services.
This absence of consequences has led to a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”
Other Conflict Zones
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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.
In Myanmar, hospitals have come under fire 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
The majority of childbirth fatalities are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births devoid of emergency care.
“When childbirth centers become intentional targets indicates a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to tear apart the social fabric,” observes a legal researcher.
“Safeguards are not guaranteed 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.”
