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

Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. 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. “A massacre was taking place inside the hospital. We who were able to escape, did so.”

This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Militiamen forced their way into the building, reportedly killing more than 460 innocent people inside.

Rights organizations have described it as “a crime beyond words,” and a prime example of the vanishing safeguards for civilians trapped in war-torn areas in several nations at war.

A Record of Violence On Childbirth Services

Although world powers have signed the international laws of war, which commit them to defending civilians, the past year has witnessed an unprecedented spike of assaults against medical infrastructure. Women undergoing childbirth are highly exposed due to their need for locally available medical care.

Research and compiled data reveal an shocking trend: nearly 300 attacks on and disruptions to 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 inevitable outcomes of conflict. They constitute a deliberate strategy of violence against reproduction.”

The majority of these incidents have happened in regions embroiled in intense conflict, where countless of women bearing children are confined.

Mothers have lost their lives, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 kidnapped, and 101 detained—sometimes during medical procedures.

A Worldwide Emergency in Maternal Health

The numbers are probably a significant underestimate, as they are limited to incidents covered by the media. In many war-torn areas, reporting is limited.

Last year, analysis showed that half of all women who died during pregnancy or childbirth resided in a war zone. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as part of the basis for genocide allegations.

Following truces, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals could not be reached.

“Our facility has endured missile strikes fired at 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 damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to birth complications.

“Russia is targeting us deliberately,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“The reality is, every facility is now a potential target,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”

Accountability Evaporates

For the over half a billion females living near active conflicts, there are minimal protections and even fewer war crimes prosecutions for those targeting maternity care.

This void of justice has created a “culture of impunity,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute acts of genocide by destroying a group's future.”

Additional Hotspots

In El Fasher, the area lacked access to 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 restricted due to 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, hospitals have come under fire 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 preventable with routine care, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births without skilled assistance.

“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” observes a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”