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A group of thirty mothers had taken refuge in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.

Working that night, a 28-year-old lab technician, 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. Those who could run, fled.”

This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Combatants stormed the facility, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have described it as “a crime beyond words,” 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

Although world powers have signed 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.

An investigation of records uncover an alarming level of violence: 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.

“This is not natural consequences of war. They represent a pattern of reproductive violence.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of women bearing children are confined.

Women have been killed, denied medical attention, 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 murdered, 15 abducted, and 101 arrested—sometimes during medical procedures.

The Global Crisis in Maternal Health

These figures likely represent a substantial underreporting, as they capture solely incidents covered by the media. In many war-torn areas, communications are sparse.

Last year, findings indicated that one in two mothers who died during pregnancy or childbirth were in a conflict area. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are destroying hospitals and wards, creating a grave danger to societal repopulation and recovery.

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 declaring certain actions a genocide.

Despite periods of calm, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals could not be reached.

“We’ve had rockets fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to problems during delivery.

“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“In fact, every facility can be under attack now,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

A Culture of Impunity

For the over half a billion females living near active conflicts, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.

This void of justice has fostered a “culture of impunity,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially 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 restricted due to a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.

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 avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted speaks to a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear 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 ‘militarily advantageous’, which has now become a standard defence.”