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

A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. 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, lived to tell the tale. “I heard the screams of women and children,” he explains. “They executed everybody inside the hospital. Those who could run, fled.”

This horrifying event stands as among the worst 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 described it as “a crime beyond words,” and a prime example of the deteriorating protection for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence Against Maternal Care

Despite every significant nation are signatories to the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Mothers in labor are particularly at risk due to their reliance on 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 bombardments of hospitals and delivery wards.

“This is not natural consequences of war. They constitute a deliberate strategy of violence against reproduction.”

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.

Women have been killed, prevented from accessing care, or forced to give birth in deplorable situations. The data also indicates that at least 68 maternal health workers have been murdered, 15 abducted, and 101 arrested—sometimes during medical procedures.

The Global Crisis in Maternal Health

Statistics are thought to be a substantial underreporting, as they only include incidents reported in news outlets. In many war-torn areas, communications are sparse.

Last year, it was reported that half of all women who lost their lives in maternal circumstances resided in a war zone. This underscores a devastating pattern.

Apart from fatalities, these attacks are destroying maternal and neonatal care facilities, posing a long-term threat to community survival.

Conditions within Gaza

In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.

Despite periods of calm, doctors report that women and children are still perishing from a lack of proper treatment, owing to severe deficits of medicine and equipment. Agencies have reported 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,” states the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or trying to alter birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to problems during delivery.

“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility can be under attack now,” states a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

A Culture of Impunity

For the more than 676 million women living within range of fighting, there are few safeguards and a stark lack of legal accountability for those targeting maternity care.

This lack of accountability has created a “environment where anything goes,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, may constitute 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 increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is limited by a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.

In Myanmar, hospitals have come under fire and dozens of midwives and patients have suffered violence over the past two years of civil war.

The Collapse of Safe Childbirth

The majority of childbirth fatalities are avoidable with standard medicine, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.

“When childbirth centers become intentional targets points toward a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to tear apart the social fabric,” notes a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”