The Targeting of Childbirth: How Women and Babies Became Targets in Global Conflicts.

Thirty women were huddled for safety 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.

On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”

This appalling incident stands as a particularly egregious examples in the ongoing war tearing the North African nation apart. Combatants raided the hospital, reportedly killing more than 460 individuals receiving care and their families.

Rights organizations have described it as “an unspeakable atrocity,” and a prime example of the vanishing safeguards for civilians living amidst warfare in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

Although world powers are signatories to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of assaults against medical infrastructure. Expectant mothers are exceptionally vulnerable due to their dependence on locally available medical care.

An investigation of records reveal 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 direct strikes on hospitals and delivery wards.

“These are not inevitable outcomes of conflict. They form a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.

Mothers have lost their lives, blocked from reaching help, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 kidnapped, and 101 detained—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a substantial underreporting, as they only include incidents documented publicly. In many war-torn areas, communications are sparse.

Last year, analysis showed that half of all women who died during pregnancy or childbirth resided in a war zone. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are wrecking critical infrastructure for mothers and babies, creating a grave danger to demographic stability.

Conditions within Gaza

In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.

Even after ceasefires, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were inaccessible.

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

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to problems during delivery.

“Russia is targeting us deliberately,” 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,” states a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”

Accountability Evaporates

For the hundreds of millions of women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those targeting maternity care.

This void of justice has created a “environment where anything goes,” argues a human rights lawyer. “Assaults against maternal services, 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 increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is limited by a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.

In Myanmar, hospitals have come under fire 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

Most maternal deaths are preventable with routine care, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births without skilled assistance.

“If maternity hospitals are being deliberately targeted points toward a broader and more sinister pattern: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” observes 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 increasingly been used as a justification.”