A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were actively in labor.
Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he states. “They executed everybody 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, allegedly slaughtering more than 460 individuals receiving care and their families.
Rights organizations have described it as “a crime beyond words,” and a prime example 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 signed the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Mothers in labor are particularly at risk due to their reliance on locally available medical care.
An investigation of records show an shocking trend: nearly 300 incidents targeting or hindering 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 represent a pattern of reproductive violence.”
The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.
Deaths have occurred, prevented from accessing care, or forced to give birth in deplorable situations. The data also indicates that at least 68 maternal health workers have been murdered, 15 taken hostage, and 101 taken into custody—sometimes during medical procedures.
A Worldwide Emergency for Mothers and Newborns
The numbers are probably a grave undercount, as they capture solely incidents reported in news outlets. In many conflict zones, reporting is limited.
Last year, analysis showed that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a devastating pattern.
In addition to the loss of life, these attacks are wrecking critical infrastructure for mothers and babies, creating a grave danger to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.
Despite periods of calm, doctors report that women and children continue to die from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were inaccessible.
“Direct shelling targeting 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 trying to alter birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to maternal health issues.
“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.
“The truth of the matter is, every facility is now a potential target,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”
Accountability Evaporates
For the over half a billion females living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those targeting maternity care.
This lack of accountability has led to a “environment where anything goes,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute acts of genocide by preventing births.”
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 limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, 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
A large proportion of mother deaths are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.
“When childbirth centers become intentional targets indicates a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” notes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”
