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Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were in the midst of labor.

Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he states. “They executed everybody inside the hospital. Survival meant running for your life.”

This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the African nation apart. Militiamen stormed the facility, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have described it as “an unspeakable atrocity,” and a stark illustration of the vanishing safeguards for civilians living amidst warfare in several nations at war.

A Record of Violence On Childbirth Services

While all major powers are signatories to the international laws of war, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are exceptionally vulnerable due to their dependence on locally available medical care.

An investigation of records 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 targeted attacks against hospitals and delivery wards.

“These incidents do not represent standard wartime hazards. They represent a pattern of reproductive violence.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where hundreds of thousands of pregnant women are trapped.

Women have been killed, prevented from accessing care, or made to have their babies in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 detained—sometimes in the act of delivering babies.

The Global Crisis in Maternal Health

The numbers are probably 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 lost their lives in maternal circumstances were in a conflict area. This underscores a devastating pattern.

In addition to the loss of life, these attacks are wrecking hospitals and wards, creating a grave danger to community survival.

Conditions within Gaza

In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as part of the basis for declaring certain actions a genocide.

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. Agencies have reported women delivering babies amidst ruins because hospitals were inaccessible.

“Our facility has endured missile strikes hitting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or aiming to influence birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to problems during delivery.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“The reality is, every facility faces the threat of assault,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

Accountability Evaporates

For the over half a billion females living within range of fighting, there are minimal protections and a stark lack of legal accountability for those attacking childbirth services.

This void of justice has created a “environment where anything goes,” argues a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by preventing births.”

Additional Hotspots

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 struck a baby care unit, resulting in tragic loss of life.

In Myanmar, medical facilities have been bombed and dozens of midwives and patients have suffered violence over the past two years of civil war.

The End of Safe Deliveries

A large proportion of mother deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that fear is now driving 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 wider and more disturbing trend: the use of violence against hospitals as a tool for terror 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 may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has increasingly been used as a justification.”