Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.
Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he explains. “A massacre was taking place inside the hospital. We who were able to escape, did so.”
This appalling incident stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Militiamen forced their way into the building, allegedly slaughtering more than 460 patients and their companions.
Rights organizations have described it as “an act of unspeakable brutality,” and a stark illustration of the vanishing safeguards for civilians living amidst warfare in multiple global hotspots.
An Unprecedented Assault On Childbirth Services
While all major powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Expectant mothers are highly exposed due to their dependence on locally available medical care.
An investigation of records show an alarming level of violence: nearly 300 violent acts against 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 natural consequences of war. They form a deliberate strategy of violence against reproduction.”
The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.
Deaths have occurred, denied medical attention, or compelled to deliver in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 kidnapped, and 101 arrested—sometimes during medical procedures.
The Global Crisis in Maternal Health
The numbers are probably a significant underestimate, as they are limited to incidents reported in news outlets. In many war-torn areas, reporting is limited.
Last year, it was reported that half of all women who died during pregnancy or childbirth resided in a war zone. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are obliterating hospitals and wards, posing a long-term threat to community survival.
The Situation in Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in genocide allegations.
Following truces, doctors report that women and children are still perishing from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were out of reach.
“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals 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. Officials from Russia have rejected deliberately targeting civilians.
“In fact, every facility is now a potential target,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”
Accountability Evaporates
For the hundreds of millions of women living close to deadly warfare, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability has led to a “culture of impunity,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as acts of genocide by hindering reproduction.”
Other Conflict Zones
In El Fasher, the area lacked access to 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 restricted due to a inability to report from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, killing mothers, babies, and nurses.
In Myanmar, medical facilities have been bombed 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
Most maternal deaths are avoidable with standard medicine, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.
“The deliberate attack on maternity wards indicates a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” says a legal researcher.
“There is no absolute protection 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.”
