A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, 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. “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 a particularly egregious examples in the ongoing war tearing the North African nation apart. Combatants stormed the facility, leaving dead more than 460 patients and their companions.
Rights organizations have called it “an unspeakable atrocity,” and a prime example of the collapse in safety for civilians caught in conflict zones in multiple global hotspots.
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 experienced a historic high of violence targeting health services. Expectant mothers are particularly at risk due to their dependence on locally available medical care.
Data analysis and investigations uncover an unprecedented scale of attacks: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These incidents do not represent natural consequences of war. They form a deliberate strategy of violence against reproduction.”
The majority of these attacks have taken place in regions embroiled in intense conflict, where a vast number of pregnant women are trapped.
Deaths have occurred, prevented from accessing care, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been murdered, 15 abducted, and 101 detained—sometimes while assisting births.
A Worldwide Emergency in Maternal Health
These figures likely represent a grave undercount, as they capture solely incidents covered by the media. In many war-torn areas, information is scarce.
Last year, it was reported that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a devastating pattern.
Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, creating a grave danger to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact 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 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 could not be reached.
“Direct shelling targeting 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 seeking to affect birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to maternal health issues.
“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” 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 near active conflicts, there are few safeguards and rare trials for atrocities for those targeting maternity care.
This absence of consequences has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute 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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, 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
Most maternal deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births lacking professional help.
“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” says 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 ‘militarily advantageous’, which has increasingly been used as a justification.”
