Childbirth Under Attack: How Women and Babies Became Casualties in Worldwide Wars.

Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were actively in labor.

Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me 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 protracted internal conflict tearing the North African nation apart. Militiamen raided the hospital, reportedly killing more than 460 patients and their companions.

Rights organizations have described it as “a crime beyond words,” and a clear case of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.

A Record of Violence Against Maternal Care

Although world powers have signed the Geneva conventions, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Expectant mothers are particularly at risk due to their reliance on locally available medical care.

An investigation of records uncover an shocking trend: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“This is not inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.

Mothers have lost their lives, 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 taken into custody—sometimes during medical procedures.

A Worldwide Emergency in Maternal Health

These figures likely represent a significant underestimate, as they capture solely incidents covered by the media. In many areas of fighting, communications are sparse.

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

In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat to community survival.

The Situation in Gaza

In Gaza, the devastating effect on the right to maternal care 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 inadequate care, owing to severe deficits of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were inaccessible.

“Direct shelling 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 trying to alter birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births occurring in shelters and extreme psychological pressure leading to birth complications.

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

“The truth of the matter is, every facility faces the threat of assault,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

A Culture of Impunity

For the more than 676 million women living close to deadly warfare, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.

This void of justice has led to a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”

Additional Hotspots

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 damaged a maternity hospital, killing mothers, babies, and nurses.

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 Collapse of Safe Childbirth

The majority of childbirth fatalities are preventable with routine care, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births lacking professional help.

“When childbirth centers become intentional targets speaks to a broader and more sinister pattern: the use of violence against hospitals as a tool for terror and to break societal cohesion,” notes a legal researcher.

“Hospitals are not completely safe 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.”