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A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, 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. “There were cries of women and children,” he recounts. “They executed everybody inside the hospital. Survival meant running for your life.”

This horrifying event stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Armed soldiers stormed the facility, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have labeled it “a crime beyond words,” and a clear case of the collapse in safety for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

Although world powers have signed the Geneva conventions, which commit them to defending civilians, the past year has experienced a historic high of attacks on healthcare systems. Women undergoing childbirth are highly exposed due to their reliance on locally available medical care.

An investigation of records show an shocking trend: nearly 300 attacks on and disruptions to 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 form 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 expectant mothers are stranded.

Women have been killed, blocked from reaching help, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.

A Worldwide Emergency in Maternal Health

Statistics are thought to be a significant underestimate, as they capture solely incidents documented publicly. In many conflict zones, reporting is limited.

Last year, findings indicated that half of all women who perished while pregnant or giving birth resided in a war zone. This underscores a horrifying trend.

Apart from fatalities, these attacks are destroying maternal and neonatal care facilities, creating a grave danger to community survival.

Conditions within Gaza

In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as part of the basis for genocide allegations.

Even after ceasefires, doctors report that women and children continue to die from a lack of proper treatment, owing to severe deficits of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.

“Direct shelling fired at the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to birth complications.

“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The reality is, every facility is now a potential target,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

Accountability Evaporates

For the more than 676 million women living within range of fighting, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.

This lack of accountability has led to a “culture of impunity,” argues a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by preventing births.”

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 scarce because of a inability to report 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 faced detention, death, or harm over the past two years of civil war.

The Collapse of Safe Childbirth

Most maternal deaths are avoidable with standard medicine, 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.

“The deliberate attack on maternity wards speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” says 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 ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”