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Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were in the midst of labor.

Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he recounts. “A massacre was taking place inside the hospital. We who were able to escape, did so.”

This appalling incident stands as a particularly egregious examples in the ongoing war tearing the North African nation apart. Armed soldiers stormed the facility, allegedly slaughtering more than 460 individuals receiving care and their families.

Rights organizations have labeled it “a crime beyond words,” and a stark illustration of the collapse in safety for civilians trapped in war-torn areas in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Expectant mothers are exceptionally vulnerable due to their reliance on locally available medical care.

Data analysis and investigations show an alarming level of violence: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“These incidents do not represent inevitable outcomes of conflict. They represent a pattern of reproductive violence.”

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

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 midwives, obstetricians, and gynaecologists have been murdered, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a substantial underreporting, as they only include incidents covered by the media. In many areas of fighting, reporting is limited.

Last year, findings indicated that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a horrifying trend.

In addition to the loss of life, these attacks are obliterating hospitals and wards, jeopardizing the future to societal repopulation and recovery.

The Situation in Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as one reason behind declaring certain actions a genocide.

Despite periods of calm, doctors report that women and children continue to die from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were inaccessible.

“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.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been struck and ruined in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to maternal health issues.

“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility is now a potential target,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

A Culture of Impunity

For the more than 676 million women living within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.

This void of justice has fostered a “environment where anything goes,” explains a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”

Other Conflict Zones

In El Fasher, the area was isolated from humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, 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 damaged a maternity hospital, killing mothers, babies, and nurses.

In Myanmar, clinics have been attacked 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

A large proportion of mother deaths are preventable with routine care, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births without skilled assistance.

“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 break societal cohesion,” says a legal researcher.

“Hospitals are not completely safe 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 now become a standard defence.”