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Thirty women were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.

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 states. “They executed everybody inside the hospital. Those who could run, fled.”

This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Combatants raided the hospital, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have called it “an act of unspeakable brutality,” and a stark illustration of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

Despite every significant nation have signed the Geneva conventions, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Women undergoing childbirth are exceptionally vulnerable due to their reliance on locally available medical care.

Data analysis and investigations reveal an alarming level of violence: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 targeted attacks against 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 assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of pregnant women are trapped.

Mothers have lost their lives, prevented from accessing care, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 arrested—sometimes while assisting births.

The Global Crisis in Maternal Health

These figures likely represent a substantial underreporting, as they are limited to incidents reported in news outlets. In many areas of fighting, communications are sparse.

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

In addition to the loss of life, these attacks are wrecking maternal and neonatal care facilities, jeopardizing the future to community survival.

Conditions within 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.

Following truces, doctors report that women and children continue to die from medical shortages, owing to severe deficits of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals were out of reach.

“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 denied deliberately targeting maternity care or seeking to affect birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to maternal health issues.

“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

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

A Culture of Impunity

For the over half a billion females living close to deadly warfare, there are scarce guarantees and even fewer war crimes prosecutions for those attacking childbirth services.

This absence of consequences has created a “atmosphere of lawlessness,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”

Other Conflict Zones

In El Fasher, the area was isolated 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, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.

The End of Safe Deliveries

Most maternal deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“If maternity hospitals are being deliberately targeted points toward a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” observes a legal researcher.

“Safeguards are not guaranteed 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 often been cited as an excuse.”