Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he states. “A massacre was taking place inside the hospital. We who were able to escape, did so.”
This appalling incident stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Combatants forced their way into the building, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have called it “a crime beyond words,” and a stark illustration of the deteriorating protection 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 have signed the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Expectant mothers are highly exposed due to their need for locally available medical care.
An investigation of records uncover an shocking trend: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“This is not natural consequences of war. They constitute a pattern of reproductive violence.”
The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.
Mothers have lost their lives, denied medical attention, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.
The Global Crisis in Maternal Health
The numbers are probably a substantial underreporting, as they only include incidents reported in news outlets. In many conflict zones, reporting is limited.
Last year, analysis showed that half of all women who lost their lives in maternal circumstances resided in a war zone. This underscores a horrifying trend.
In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, jeopardizing the future to societal repopulation and recovery.
Conditions within Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as one reason behind accusations of genocidal acts.
Despite periods of calm, doctors report that women and children succumb from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.
“Direct shelling targeting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births taking place in basements and skyrocketing stress leading to birth complications.
“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The reality is, every facility can be under attack now,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”
A Culture of Impunity
For the more than 676 million women living within range of fighting, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.
This lack of accountability 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 preventing births.”
Other Conflict Zones
In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition rising sharply, especially among children and pregnant women.
In the Democratic Republic of the Congo, information is restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.
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
A large proportion of mother deaths are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births lacking professional help.
“The deliberate attack on maternity wards indicates a wider and more disturbing trend: the use of attacks on medical facilities as a tool for terror and to tear apart the social fabric,” notes 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 often been cited as an excuse.”
