Childbirth Under Attack: The Making of Women and Babies into Casualties in Worldwide Wars.

A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were in the midst of labor.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he states. “A massacre was taking place inside the hospital. Survival meant running for your life.”

This appalling incident stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Combatants 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 prime example of the collapse in safety for civilians trapped in war-torn areas in multiple global hotspots.

An Unprecedented Assault On Childbirth Services

While all major powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are highly exposed due to their need for locally available medical care.

Research and compiled data show an alarming level of violence: nearly 300 attacks on and disruptions to 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 form a pattern of reproductive violence.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of expectant mothers are stranded.

Women have been killed, denied medical attention, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a substantial underreporting, as they are limited to incidents documented publicly. In many conflict zones, reporting is limited.

Last year, analysis showed that half of all women who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.

Apart from fatalities, these attacks are destroying critical infrastructure for mothers and babies, creating a grave danger to societal repopulation and recovery.

The Situation in Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.

Despite periods of calm, doctors report that women and children are still perishing from medical shortages, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were inaccessible.

“Our facility has endured missile strikes 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 seeking to affect birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births taking place in basements and skyrocketing stress leading to birth complications.

“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”

Accountability Evaporates

For the over half a billion females living within range of fighting, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.

This lack of accountability has fostered a “culture of impunity,” argues 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 had been cut off 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 struck a baby care unit, resulting in tragic loss of life.

In Myanmar, clinics have been attacked 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 anxiety is forcing women away from facilities once considered safe, leading them to risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of violence against hospitals as a weapon to spread fear 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 ‘harmful to the enemy’, which has now become a standard defence.”