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A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were actively in labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he explains. “They executed everybody inside the hospital. Survival meant running for your life.”

This horrifying event stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Armed soldiers forced their way into the building, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have labeled it “a crime beyond words,” and a clear case of the deteriorating protection for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

Although world powers have agreed to the Geneva conventions, which obligate them to protect 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.

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

“This is not inevitable outcomes of conflict. They constitute a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.

Mothers have lost their lives, blocked from reaching help, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been murdered, 15 kidnapped, and 101 arrested—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a grave undercount, as they only include incidents covered by the media. In many war-torn areas, information is scarce.

Last year, findings indicated 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 destroying maternal and neonatal care facilities, posing a long-term threat 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 accusations of genocidal acts.

Following truces, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were inaccessible.

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

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births forced underground and skyrocketing stress leading to maternal health issues.

“We are being singled out,” 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 can strike a hospital.”

Accountability Evaporates

For the hundreds of millions of women living within range of fighting, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.

This lack of accountability has created a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, 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 increasing drastically, 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 struck a baby care unit, killing mothers, babies, and nurses.

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 Collapse of Safe Childbirth

A large proportion of mother deaths are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.

“The deliberate attack on maternity wards indicates a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” notes a legal researcher.

“Hospitals are not completely safe 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.”