The Targeting of Childbirth: The Making of Women and Babies into Targets in Global Conflicts.

Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were actively in labor.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he recounts. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This brutal attack stands as a particularly egregious examples in the protracted internal conflict tearing the African nation apart. Militiamen forced their way into the building, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have called it “a crime beyond words,” and a clear case of the collapse in safety for civilians caught in conflict zones in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.

Research and compiled data uncover an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“These are not inevitable outcomes of conflict. They represent a systematic assault on childbirth.”

The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where a vast number of women bearing children are confined.

Deaths have occurred, denied medical attention, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

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

Last year, it was reported that half of all women who perished while pregnant or giving birth were in a conflict area. This underscores a devastating pattern.

Beyond killing women and staff, these attacks are obliterating hospitals and wards, posing a long-term threat to demographic stability.

The Situation in Gaza

In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as a factor in declaring certain actions a genocide.

Following truces, doctors report that women and children are still perishing from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals could not be reached.

“We’ve had rockets fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and skyrocketing stress leading to problems during delivery.

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

“The truth of the matter is, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

Accountability Evaporates

For the more than 676 million women living near active conflicts, there are minimal protections and even fewer war crimes prosecutions for those assaulting reproductive health.

This lack of accountability has created a “atmosphere of lawlessness,” argues 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 lacked access to 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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, killing mothers, babies, and nurses.

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 Collapse of Safe Childbirth

Most maternal deaths are avoidable with standard medicine, 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.

“When childbirth centers become intentional targets points toward a broader and more sinister pattern: the use of violence against hospitals as a tool for terror 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 may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has often been cited as an excuse.”