Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were experiencing childbirth.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he recounts. “A massacre was taking place inside the hospital. We who were able to escape, did so.”
This appalling incident stands as a particularly egregious examples in the two-year civil war tearing the North African nation apart. Combatants raided the hospital, reportedly killing more than 460 individuals receiving care and their families.
Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the deteriorating protection for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.
A Record of Violence Against Maternal Care
While all major powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are particularly at risk due to their dependence on locally available medical care.
Research and compiled data reveal an alarming level of violence: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.
“These incidents do not represent standard wartime hazards. They constitute a systematic assault on childbirth.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.
Mothers have lost their lives, prevented from accessing care, or forced to give birth in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 taken hostage, and 101 taken into custody—sometimes while assisting births.
The Global Crisis in Maternal Health
The numbers are probably a grave undercount, as they only include incidents reported in news outlets. In many conflict zones, communications are sparse.
Last year, it was reported that 50% of women who perished while pregnant or giving birth lived amidst hostilities. This underscores a horrifying trend.
Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, creating a grave danger to community survival.
The Situation in Gaza
In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as part of the basis for declaring certain actions a genocide.
Despite periods of calm, doctors report that women and children succumb from inadequate care, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.
“Direct shelling fired at 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 seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births taking place in basements and skyrocketing stress leading to maternal health issues.
“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The reality is, every facility can be under attack now,” comments a medical director in Sumy. “If a drone is destroyed, 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 few safeguards and rare trials for atrocities for those targeting maternity care.
This lack of accountability has fostered a “environment where anything goes,” says a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially acts of genocide by preventing births.”
Other Conflict Zones
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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.
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
A large proportion of mother deaths are avoidable with standard medicine, 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 without skilled assistance.
“If maternity hospitals are being deliberately targeted speaks to a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to tear apart the social fabric,” observes 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 ‘harmful to the enemy’, which has now become a standard defence.”
