Thirty 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 actively in labor.
On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he explains. “They were killing everyone inside the hospital. Survival meant running for your life.”
This horrifying event stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Militiamen stormed the facility, reportedly killing more than 460 patients and their companions.
Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the collapse in safety for civilians caught in conflict zones in multiple global hotspots.
A Record of Violence On Childbirth Services
Although world powers have signed the international laws of war, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Expectant mothers are particularly at risk due to their need for locally available medical care.
Research and compiled data uncover an shocking trend: 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 are not standard wartime hazards. They represent a deliberate strategy of violence against reproduction.”
The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of women bearing children are confined.
Deaths have occurred, blocked from reaching help, or compelled to deliver 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 while assisting births.
A Worldwide Emergency in Maternal Health
These figures likely represent a significant underestimate, as they are limited to incidents reported in news outlets. In many war-torn areas, reporting is limited.
Last year, it was reported that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a catastrophic reality.
Apart from fatalities, these attacks are wrecking hospitals and wards, jeopardizing the future to demographic stability.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind genocide allegations.
Following truces, doctors report that women and children continue to die from medical shortages, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were out of reach.
“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or trying to alter birthrates.
Ukraine's Ordeal
Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to birth complications.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.
“The truth of the matter is, every facility can be under attack now,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”
Accountability Evaporates
For the more than 676 million women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.
This lack of accountability has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute acts of genocide by destroying a group's future.”
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 scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, causing fatalities among patients and staff.
In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.
The End of Safe Deliveries
Most maternal deaths are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.
“When childbirth centers become intentional targets speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” notes 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.”
