Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Among them were new mothers, 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 explains. “They executed everybody inside the hospital. We who were able to escape, did so.”
This brutal attack stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Combatants raided the hospital, allegedly slaughtering more than 460 individuals receiving care and their families.
Rights organizations have labeled it “an unspeakable atrocity,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in several nations at war.
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 witnessed an unprecedented spike of assaults against medical infrastructure. Expectant mothers are particularly at risk due to their need for locally available medical care.
Data analysis and investigations uncover an alarming level of violence: nearly 300 violent acts against 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 natural consequences of war. They form a deliberate strategy of violence against reproduction.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of women bearing children are confined.
Women have been killed, blocked from reaching help, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.
The Global Crisis for Mothers and Newborns
These figures likely represent a substantial underreporting, as they capture solely incidents reported in news outlets. In many areas of fighting, communications are sparse.
Last year, it was reported that half of all women who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.
In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat to societal repopulation and recovery.
The Situation in Gaza
In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in declaring certain actions a genocide.
Even after ceasefires, doctors report that women and children continue to die from medical shortages, owing to severe deficits of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were out of reach.
“Our facility has endured missile strikes targeting 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 seeking to affect birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to maternal health issues.
“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The reality is, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”
Accountability Evaporates
For the hundreds of millions of women living within range of fighting, there are minimal protections and rare trials for atrocities for those targeting maternity care.
This absence of consequences has created a “culture of impunity,” explains a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by destroying a group's future.”
Other Conflict Zones
In El Fasher, the area was isolated 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 inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.
In Myanmar, hospitals have come under fire 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 preventable with routine care, but war collapses medical infrastructure. 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 points toward a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” observes a legal researcher.
“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”
