The Targeting of Childbirth: How Women and Babies Became Casualties in Worldwide Wars.

Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.

Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he states. “They were killing everyone inside the hospital. Survival meant running for your life.”

This appalling incident stands as one of the most shocking examples in the ongoing war tearing the African nation apart. Combatants forced their way into the building, leaving dead 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 collapse in safety for civilians caught in conflict zones in several nations at war.

A Record of Violence Against Maternal Care

While all major powers are signatories to the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of assaults against medical infrastructure. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.

An investigation of records uncover an alarming level of violence: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These incidents do not represent inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”

The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of pregnant women are trapped.

Women have been killed, prevented from accessing care, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 taken hostage, and 101 detained—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

These figures likely represent a significant underestimate, as they capture solely incidents reported in news outlets. In many areas of fighting, information is scarce.

Last year, findings indicated that half of all women who perished while pregnant or giving birth lived amidst hostilities. This underscores a devastating pattern.

Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, posing a long-term threat to community survival.

Conditions within Gaza

In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind declaring certain actions a genocide.

Following truces, doctors report that women and children are still perishing from medical shortages, owing to desperate lacks of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were inaccessible.

“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 rejected deliberately targeting maternity care or trying to alter birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to problems during delivery.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The reality is, every facility can be under attack now,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”

Accountability Evaporates

For the over half a billion females living within range of fighting, there are few safeguards and even fewer war crimes prosecutions for those attacking childbirth services.

This void of justice has created a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by hindering reproduction.”

Additional Hotspots

In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, 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 hit a neonatal ward, causing fatalities among patients and staff.

In Myanmar, medical facilities have been bombed 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 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 devoid of emergency care.

“If maternity hospitals are being deliberately targeted 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,” says 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.”