A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he recounts. “A massacre was taking place inside the hospital. Those who could run, fled.”
This horrifying event stands as among the worst examples in the two-year civil war tearing the North African nation apart. Armed soldiers stormed the facility, reportedly killing more than 460 innocent people inside.
Rights organizations have called it “an act of unspeakable brutality,” and a prime example of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault On Childbirth Services
Although world powers are signatories to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Mothers in labor are particularly at risk due to their dependence on locally available medical care.
Research and compiled data uncover an unprecedented scale of attacks: nearly 300 incidents targeting or hindering places and people associated with childbirth 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 represent a deliberate strategy of violence against reproduction.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.
Women have been killed, denied medical attention, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
The numbers are probably a significant underestimate, as they capture solely incidents covered by the media. In many conflict zones, reporting is limited.
Last year, it was reported that one in two mothers who lost their lives in maternal circumstances lived amidst hostilities. This underscores a devastating pattern.
In addition to the loss of life, these attacks are obliterating hospitals and wards, creating a grave danger to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Even after ceasefires, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.
“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to birth complications.
“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.
“The reality is, 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 hundreds of millions of women living close to deadly warfare, there are minimal protections and a stark lack of legal accountability for those assaulting reproductive health.
This absence of consequences has led to a “culture of impunity,” explains 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 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, 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 End of Safe Deliveries
The majority of childbirth fatalities are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births devoid of emergency care.
“When childbirth centers become intentional targets speaks to a wider and more disturbing trend: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” says a legal researcher.
“Hospitals are not completely safe 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 often been cited as an excuse.”
