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Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were actively in labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he recounts. “They executed everybody inside the hospital. Survival meant running for your life.”

This brutal attack stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Armed soldiers raided the hospital, leaving dead more than 460 individuals receiving care and their families.

Rights organizations have called it “a crime beyond words,” and a prime example of the vanishing safeguards for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

While all major powers are signatories to the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are exceptionally vulnerable due to their dependence on locally available medical care.

Data analysis and investigations uncover an unprecedented scale of attacks: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These are not standard wartime hazards. They form a deliberate strategy of violence against reproduction.”

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

Mothers have lost their lives, prevented from accessing care, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 kidnapped, and 101 arrested—sometimes while assisting births.

The Global Crisis for Mothers and Newborns

The numbers are probably a significant underestimate, as they are limited to incidents reported in news outlets. In many areas of fighting, reporting is limited.

Last year, it was reported that 50% of women who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to demographic stability.

Conditions within Gaza

In Gaza, the devastating effect 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 medical shortages, owing to desperate lacks of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were inaccessible.

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

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and extreme psychological pressure leading to maternal health issues.

“Russia is targeting us deliberately,” 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,” states a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”

Accountability Evaporates

For the hundreds of millions of women living near active conflicts, there are few safeguards and even fewer war crimes prosecutions for those targeting maternity care.

This absence of consequences has created a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by preventing births.”

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 damaged a maternity hospital, resulting in tragic loss of life.

In Myanmar, clinics have been attacked 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

The majority of childbirth fatalities are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in 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 weapon to spread fear 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 now become a standard defence.”