Dozens of women had taken refuge in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were in the midst of labor.
Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he states. “They were killing everyone inside the hospital. Survival meant running for your life.”
This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Combatants raided the hospital, reportedly killing more than 460 patients and their companions.
Rights organizations have called it “an act of unspeakable brutality,” and a stark illustration of the vanishing safeguards for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
An Unprecedented Assault Against Maternal Care
While all major powers have signed the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are particularly at risk due to their dependence on locally available medical care.
An investigation of records reveal an shocking trend: 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 are not inevitable outcomes of conflict. They form a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.
Deaths have occurred, blocked from reaching help, or compelled to deliver in deplorable situations. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 arrested—sometimes during medical procedures.
A Worldwide Emergency in Maternal Health
Statistics are thought to be a grave undercount, as they are limited to incidents documented publicly. In many areas of fighting, information is scarce.
Last year, analysis showed that half of all women who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.
In addition to the loss of life, these attacks are destroying maternal and neonatal care facilities, posing a long-term threat 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 a factor in accusations of genocidal acts.
Following truces, doctors report that women and children continue to die from a lack of proper treatment, owing to desperate lacks of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were out of reach.
“Direct shelling 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 aiming to influence birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births forced underground and skyrocketing stress leading to birth complications.
“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“In fact, every facility is now a potential target,” notes 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 hundreds of millions of women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those assaulting reproductive health.
This void of justice has fostered a “atmosphere of lawlessness,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, are potentially 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 increasing drastically, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.
In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
The majority of childbirth fatalities are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“The deliberate attack on maternity wards indicates a wider and more disturbing trend: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” notes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”
