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A group of thirty mothers were seeking shelter in a maternity hospital 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, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he recounts. “They executed everybody inside the hospital. Survival meant running for your life.”

This brutal attack stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen stormed the facility, leaving dead more than 460 individuals receiving care and their families.

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

An Unprecedented Assault On Childbirth Services

While all major powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are highly exposed due to their need for locally available medical care.

An investigation of records uncover 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 incidents do not represent inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”

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

Mothers have lost their lives, denied medical attention, or made to have their babies in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 kidnapped, and 101 arrested—sometimes during medical procedures.

A Worldwide Emergency in Maternal Health

Statistics are thought to be a substantial underreporting, as they capture solely incidents reported in news outlets. In many areas of fighting, communications are sparse.

Last year, analysis showed that one in two mothers who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, creating a grave danger to community survival.

The Situation in Gaza

In Gaza, the catastrophic impact 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 a lack of proper treatment, owing to desperate lacks of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals could not be reached.

“Direct shelling fired at the wards, operating rooms, and maternity wards,” explains 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. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to birth complications.

“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“The reality is, every facility can be under attack now,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”

Accountability Evaporates

For the hundreds of millions of women living near active conflicts, there are scarce guarantees and rare trials for atrocities for those attacking childbirth services.

This void of justice has fostered a “environment where anything goes,” 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 had been cut off from humanitarian aid long before the hospital attack, with malnutrition rising sharply, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.

In Myanmar, hospitals have come under fire 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

The majority of childbirth fatalities are preventable with routine care, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births devoid of emergency care.

“The deliberate attack on maternity wards 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,” says a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”