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 maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were experiencing childbirth.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he recounts. “They were killing everyone inside the hospital. Those who could run, fled.”

This horrifying event stands as among the worst examples in the two-year civil war tearing the African nation apart. Combatants raided the hospital, reportedly killing more than 460 individuals receiving care and their families.

Rights organizations have labeled it “an unspeakable atrocity,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.

A Record of Violence Against Maternal Care

Despite every significant nation have signed the international laws of war, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Mothers in labor are highly exposed due to their dependence on locally available medical care.

An investigation of records show 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 targeted attacks against hospitals and delivery wards.

“These incidents do not represent natural consequences of war. They form 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 expectant mothers are stranded.

Women have been killed, prevented from accessing care, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 taken hostage, and 101 detained—sometimes during medical procedures.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a significant underestimate, as they only include incidents reported in news outlets. In many conflict zones, reporting is limited.

Last year, analysis showed that 50% of women who lost their lives in maternal circumstances were in a conflict area. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to community survival.

The Situation in Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in declaring certain actions a genocide.

Despite periods of calm, doctors report that women and children continue to die from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were out of reach.

“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 seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to maternal health issues.

“The attacks on us are intentional,” says 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,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

A Culture of Impunity

For the more than 676 million women living close to deadly warfare, there are minimal protections and a stark lack of legal accountability for those targeting maternity care.

This lack of accountability has created a “culture of impunity,” says 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.”

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 scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.

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 averted with basic healthcare, 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 points toward a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to tear apart the social fabric,” observes 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 ‘militarily advantageous’, which has often been cited as an excuse.”