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Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, 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. “There were cries of women and children,” he recounts. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This appalling incident stands as among the worst examples in the two-year civil war tearing the African nation apart. Militiamen stormed the facility, reportedly killing more than 460 innocent people inside.

Rights organizations have labeled it “an act of unspeakable brutality,” and a prime example of the deteriorating protection for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault On Childbirth Services

Although world powers are signatories to the international laws of war, which obligate them to protect 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.

Data analysis and investigations reveal 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 direct strikes on hospitals and delivery wards.

“These incidents do not represent natural consequences of war. They represent a systematic assault on childbirth.”

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

Women have been killed, denied medical attention, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 abducted, and 101 detained—sometimes in the act of delivering babies.

The Global Crisis in Maternal Health

The numbers are probably a substantial underreporting, as they only include incidents documented publicly. In many areas of fighting, reporting is limited.

Last year, findings indicated that 50% of women who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are obliterating hospitals and wards, 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.

Following truces, doctors report that women and children succumb from a lack of proper treatment, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.

“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has contested 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 maternal health issues.

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

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

Accountability Evaporates

For the over half a billion females living close to deadly warfare, there are minimal protections and even fewer war crimes prosecutions for those assaulting reproductive health.

This void of justice has led to a “culture of impunity,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute acts of genocide by destroying a group's future.”

Additional Hotspots

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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.

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 preventable with routine care, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“The deliberate attack on maternity wards indicates a larger and alarming strategy: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” observes a legal researcher.

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