Dozens of women were seeking shelter in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. 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, became one of the few known survivors. “I heard the screams of women and children,” he explains. “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 protracted internal conflict tearing the North African nation apart. Militiamen raided the hospital, leaving dead more than 460 patients and their companions.
Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the deteriorating protection for civilians trapped in war-torn areas in several nations at war.
An Unprecedented Assault Against Maternal Care
Despite every significant nation have signed the international laws of war, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Women undergoing childbirth are exceptionally vulnerable due to their reliance on locally available medical care.
Research and compiled data uncover an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.
“These incidents do not represent inevitable outcomes of conflict. They form a pattern of reproductive violence.”
The majority of these assaults have occurred in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.
Women have been killed, blocked from reaching help, or forced to give birth in deplorable situations. The data also indicates that at least 68 maternal health workers have been murdered, 15 abducted, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis in Maternal Health
These figures likely represent a significant underestimate, as they only include incidents reported in news outlets. In many areas of fighting, communications are sparse.
Last year, it was reported that one in two mothers who lost their lives in maternal circumstances resided in a war zone. This underscores a devastating pattern.
In addition to the loss of life, these attacks are wrecking hospitals and wards, posing a long-term threat to community survival.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.
Even after ceasefires, doctors report that women and children are still perishing from medical shortages, owing to severe deficits of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals could not be reached.
“We’ve had rockets fired at 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 attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births forced underground 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. Russian authorities have denied deliberately targeting civilians.
“In fact, every facility faces the threat of assault,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”
Accountability Evaporates
For the more than 676 million women living near active conflicts, there are few safeguards and even fewer war crimes prosecutions for those attacking childbirth services.
This absence of consequences has fostered a “atmosphere of lawlessness,” argues a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”
Additional Hotspots
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 scarce because of a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.
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 End of Safe Deliveries
Most maternal deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.
“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to tear apart the social fabric,” observes a legal researcher.
“Hospitals are not completely safe 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.”
