Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were in the midst of labor.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he explains. “A massacre was taking place inside the hospital. Survival meant running for your life.”
This appalling incident stands as a particularly egregious examples in the two-year civil war tearing the North African nation apart. Combatants forced their way into the building, reportedly killing more than 460 innocent people inside.
Rights organizations have called it “a crime beyond words,” and a prime example of the collapse in safety for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault On Childbirth Services
Despite every significant nation have agreed to the international laws of war, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.
An investigation of records reveal an unprecedented scale of attacks: 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 incidents do not represent inevitable outcomes of conflict. They constitute a systematic assault on childbirth.”
The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of expectant mothers are stranded.
Women have been killed, 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 abducted, 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 conflict zones, communications are sparse.
Last year, findings indicated that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.
In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, creating a grave danger to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as a factor in genocide allegations.
Despite periods of calm, doctors report that women and children are still perishing from inadequate care, owing to severe deficits of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were inaccessible.
“Our facility has endured missile strikes hitting 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 trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to birth complications.
“Russia is targeting us deliberately,” says 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,” comments 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 over half a billion females living within range of fighting, there are scarce guarantees and even fewer war crimes prosecutions for those targeting maternity care.
This void of justice has fostered a “atmosphere of lawlessness,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute 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, medical facilities have been bombed and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.
The Collapse of Safe Childbirth
A large proportion of mother deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births lacking professional help.
“When childbirth centers become intentional targets points toward a wider and more disturbing trend: the use of violence against hospitals as a weapon to spread fear and to tear apart the social fabric,” 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 now become a standard defence.”
