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Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were experiencing childbirth.

Working that night, 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. “They executed everybody inside the hospital. We who were able to escape, did so.”

This horrifying event stands as among the worst examples in the two-year civil war tearing the African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have labeled it “an act of unspeakable brutality,” and a prime example of the vanishing safeguards for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault On Childbirth Services

While all major powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of assaults against medical infrastructure. Mothers in labor are exceptionally vulnerable due to their need for locally available medical care.

Research and compiled data uncover an alarming level of violence: 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 incidents do not represent natural consequences of war. They represent a deliberate strategy of violence against reproduction.”

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

Mothers have lost their lives, blocked from reaching help, or forced to give birth in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.

A Worldwide Emergency in Maternal Health

Statistics are thought to be a significant underestimate, as they are limited to incidents reported in news outlets. In many conflict zones, communications are sparse.

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

Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, 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 part of the basis for accusations of genocidal acts.

Despite periods of calm, doctors report that women and children are still perishing from inadequate care, owing to severe deficits of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were inaccessible.

“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or aiming to influence birthrates.

The Crisis in Ukraine

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

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

“In fact, every facility faces the threat of assault,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

A Culture of Impunity

For the over half a billion females living near active conflicts, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.

This absence of consequences has created a “culture of impunity,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially 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 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 struck a baby care unit, 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

A large proportion of mother deaths are preventable with routine care, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births lacking professional help.

“When childbirth centers become intentional targets indicates 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.

“Hospitals are not completely safe 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 increasingly been used as a justification.”