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

Dozens of women were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were in the midst of labor.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “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 brutal attack stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Militiamen raided the hospital, allegedly slaughtering more than 460 individuals receiving care and their families.

Rights organizations have called it “an act of unspeakable brutality,” and a prime example of the vanishing safeguards for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

Despite every significant nation have signed the Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Mothers in labor are highly exposed due to their need for locally available medical care.

Research and compiled data show an alarming level of violence: nearly 300 violent acts against 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 constitute a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of pregnant women are trapped.

Women have been killed, denied medical attention, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 detained—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

The numbers are probably a grave undercount, as they capture solely incidents documented publicly. In many war-torn areas, information is scarce.

Last year, findings indicated that 50% of women who perished while pregnant or giving birth lived amidst hostilities. This underscores a horrifying trend.

Apart from fatalities, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat 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 a factor in genocide allegations.

Following truces, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals could not be reached.

“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births occurring in shelters 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. The government has disputed deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

Accountability Evaporates

For the hundreds of millions of women living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.

This absence of consequences has led to a “atmosphere of lawlessness,” argues a human rights lawyer. “Attacks on reproductive healthcare, 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 restricted due to 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 End of Safe Deliveries

The majority of childbirth fatalities are avoidable with standard medicine, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births devoid of emergency care.

“The deliberate attack on maternity wards speaks to a wider and more disturbing trend: the use of violence against hospitals as a weapon to spread fear and to tear apart the social fabric,” notes a legal researcher.

“There is no absolute protection 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.”