Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he recounts. “They executed everybody inside the hospital. Those who could run, fled.”
This brutal attack stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen 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 stark illustration of the deteriorating protection for civilians living amidst warfare in several nations at war.
A Record of Violence Against Maternal Care
While all major powers have agreed to the Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Expectant mothers are particularly at risk due to their need for locally available medical care.
Research and compiled data reveal 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 are not inevitable outcomes of conflict. They represent a pattern of reproductive violence.”
The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where hundreds of thousands of women bearing children are confined.
Deaths have occurred, prevented from accessing care, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 arrested—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
These figures likely represent a substantial underreporting, as they only include incidents covered by the media. In many war-torn areas, reporting is limited.
Last year, findings indicated 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 critical infrastructure for mothers and babies, creating a grave danger to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as a factor in accusations of genocidal acts.
Following truces, doctors report that women and children continue to die from inadequate care, owing to critical shortages of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were inaccessible.
“Our facility has endured missile strikes hitting 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 trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to birth complications.
“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The reality 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.”
Accountability Evaporates
For the over half a billion females living close to deadly warfare, there are minimal protections and rare trials for atrocities for those attacking childbirth services.
This absence of consequences has created a “atmosphere of lawlessness,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, may constitute acts of genocide by hindering reproduction.”
Additional Hotspots
In El Fasher, the area had been cut off from humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is limited by a inability to report from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, 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 Collapse of Safe Childbirth
Most maternal deaths are preventable with routine care, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“When childbirth centers become intentional targets speaks to a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to break societal cohesion,” notes 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 ‘prejudicial to the opposing side’, which has now become a standard defence.”