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Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were experiencing childbirth.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he recounts. “They executed everybody inside the hospital. We who were able to escape, did so.”

This appalling incident stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have labeled it “an unspeakable atrocity,” and a prime example of the deteriorating protection for civilians living amidst warfare in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

Although world powers have agreed to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of attacks on healthcare systems. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.

Research and compiled data uncover an alarming level of violence: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“This is not natural consequences of war. They constitute a deliberate strategy of violence against reproduction.”

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

Mothers have lost their lives, denied medical attention, or forced to give birth in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 abducted, and 101 taken into custody—sometimes during medical procedures.

A Worldwide Emergency in Maternal Health

These figures likely represent a significant underestimate, as they only include incidents documented publicly. In many conflict zones, information is scarce.

Last year, it was reported that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are destroying hospitals and wards, posing a long-term threat to community survival.

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 genocide allegations.

Despite periods of calm, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.

“We’ve had rockets 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 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. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to problems during delivery.

“We are being singled out,” says 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,” comments 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 near active conflicts, there are scarce guarantees and rare trials for atrocities for those attacking childbirth services.

This void of justice has led to a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as 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 rising sharply, 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 hit a neonatal ward, resulting in tragic loss of life.

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 End of Safe Deliveries

Most maternal deaths are preventable with routine care, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births lacking professional help.

“When childbirth centers become intentional targets speaks to a larger and alarming strategy: the use of attacks on medical facilities as a weapon to spread fear 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 can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”