Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were in the midst of labor.
Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he recounts. “A massacre was taking place inside the hospital. Those who could run, fled.”
This brutal attack stands as among the worst examples in the two-year civil war tearing the African nation apart. Armed soldiers forced their way into the building, leaving dead more than 460 individuals receiving care and their families.
Rights organizations have described it as “an unspeakable atrocity,” and a stark illustration of the collapse in safety for civilians trapped in war-torn areas in several nations at war.
A Record of Violence Against Maternal Care
Although world powers have signed the Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Women undergoing childbirth are particularly at risk due to their dependence on locally available medical care.
Research and compiled data show an unprecedented scale of attacks: 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 are not natural consequences of war. They form a pattern of reproductive violence.”
The majority of these attacks have taken place 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 compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been killed, 15 abducted, and 101 taken into custody—sometimes during medical procedures.
The Global Crisis for Mothers and Newborns
The numbers are probably a significant underestimate, as they only include incidents reported in news outlets. In many conflict zones, communications are sparse.
Last year, findings indicated that half of all women who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.
Beyond killing women and staff, these attacks are wrecking critical infrastructure for mothers and babies, creating a grave danger to community survival.
Conditions within Gaza
In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as a factor in declaring certain actions a genocide.
Following truces, doctors report that women and children are still perishing from inadequate care, owing to severe deficits of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals were out of reach.
“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or aiming to influence birthrates.
The Crisis in Ukraine
Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to problems during delivery.
“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.
“The truth of the matter is, 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.”
A Culture of Impunity
For the more than 676 million women living near active conflicts, there are scarce guarantees and even fewer war crimes prosecutions for those targeting maternity care.
This lack of accountability has led to a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by hindering reproduction.”
Other Conflict Zones
In El Fasher, the area was isolated from 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 limited by 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 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 preventable with routine care, but war shatters health systems. 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.
“The deliberate attack on maternity wards indicates a broader and more sinister pattern: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” observes a legal researcher.
“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”
