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Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were in the midst of labor.

On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams 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 protracted internal conflict tearing the African nation apart. Combatants forced their way into the building, leaving dead more than 460 individuals receiving care and their families.

Rights organizations have labeled it “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence On Childbirth Services

While all major powers have signed the international laws of war, which commit them to defending civilians, the past year has witnessed an unprecedented spike of assaults against medical infrastructure. Mothers in labor are highly exposed due to their reliance on locally available medical care.

Data analysis and investigations uncover an shocking trend: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“This is not natural consequences of war. 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 expectant mothers are stranded.

Deaths have occurred, blocked from reaching help, or compelled to deliver in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 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 only include incidents documented publicly. In many areas of fighting, communications are sparse.

Last year, it was reported that one in two mothers who lost their lives in maternal circumstances lived amidst hostilities. This underscores a devastating pattern.

Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, creating a grave danger to community survival.

The Situation in Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as one reason behind accusations of genocidal acts.

Even after ceasefires, doctors report that women and children succumb from medical shortages, owing to desperate lacks of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were out of reach.

“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or trying to alter birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and extreme psychological pressure leading to birth complications.

“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The truth of the matter is, every facility is now a potential target,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”

Accountability Evaporates

For the more than 676 million women living near active conflicts, there are minimal protections and even fewer war crimes prosecutions for those targeting maternity care.

This void of justice has fostered a “environment where anything goes,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially acts of genocide by preventing births.”

Additional Hotspots

In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.

In Myanmar, hospitals have come under fire 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

Most maternal deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births lacking professional help.

“When childbirth centers become intentional targets speaks to a wider and more disturbing trend: the use of violence against hospitals as a weapon to spread fear 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 can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”