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A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were in the midst of labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “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 brutal attack stands as among the worst examples in the two-year civil war tearing the North African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have described it as “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection for civilians caught in conflict zones in several nations at war.

An Unprecedented Assault On Childbirth Services

While all major powers have signed the Geneva conventions, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are highly exposed due to their dependence on locally available medical care.

Data analysis and investigations show an shocking trend: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These are not standard wartime hazards. They represent a systematic assault on childbirth.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.

Mothers have lost their lives, prevented from accessing care, or forced to give birth in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.

The Global Crisis in Maternal Health

These figures likely represent a significant underestimate, as they are limited to incidents documented publicly. In many areas of fighting, information is scarce.

Last year, it was reported that 50% of women who perished while pregnant or giving birth were in a conflict area. This underscores a devastating pattern.

Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, creating a grave danger 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 severe deficits of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were out of reach.

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

The Crisis in Ukraine

Since early 2022, at least 80 hospitals for mothers and babies have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress 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 can be under attack now,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

Accountability Evaporates

For the more than 676 million women living close to deadly warfare, there are minimal protections and a stark lack of legal accountability for those assaulting reproductive health.

This void of justice has led to a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, are potentially acts of genocide by destroying a group's future.”

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 limited by a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.

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 avoidable with standard medicine, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births lacking professional help.

“The deliberate attack on maternity wards points toward a larger and alarming strategy: the use of attacks on medical facilities as a weapon to spread fear and to break societal cohesion,” observes 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 ‘harmful to the enemy’, which has increasingly been used as a justification.”