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A group of thirty mothers had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were actively in labor.

Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he states. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Militiamen stormed the facility, reportedly killing more than 460 individuals receiving care and their families.

Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

While all major powers have signed the international laws of war, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of violence targeting health services. 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 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These are not inevitable outcomes of conflict. They constitute a pattern of reproductive violence.”

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of expectant mothers are stranded.

Deaths have occurred, prevented from accessing care, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.

The Global Crisis for Mothers and Newborns

These figures likely represent a substantial underreporting, as they are limited to incidents documented publicly. In many conflict zones, reporting is limited.

Last year, analysis showed that one in two mothers who died during pregnancy or childbirth lived amidst hostilities. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, posing a long-term threat to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.

Even after ceasefires, doctors report that women and children are still perishing 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.

“Direct shelling hitting the wards, operating rooms, and maternity wards,” explains 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 childbirth centers have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births taking place in basements and skyrocketing stress leading to birth complications.

“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 faces the threat of assault,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”

A Culture of Impunity

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

This void of justice has fostered a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, may constitute acts of genocide by preventing births.”

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 limited by a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.

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 Collapse of Safe Childbirth

A large proportion of mother deaths are preventable with routine care, 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 broader and more sinister pattern: the use of violence against hospitals as a tool for terror and to tear apart the social fabric,” 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 often been cited as an excuse.”