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Dozens of women had taken refuge in a maternity hospital in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were experiencing childbirth.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he recounts. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This appalling incident stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers stormed the facility, reportedly killing more than 460 innocent people inside.

Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the deteriorating protection for civilians living amidst warfare in several nations at war.

A Record of Violence On Childbirth Services

Despite every significant nation are signatories to the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of attacks on healthcare systems. Mothers in labor are particularly at risk due to their need for locally available medical care.

An investigation of records uncover an shocking trend: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“These are not standard wartime hazards. They form a pattern of reproductive violence.”

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, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 detained—sometimes while assisting births.

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 conflict zones, communications are sparse.

Last year, analysis showed that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.

Apart from fatalities, these attacks are destroying hospitals and wards, posing a long-term threat to demographic stability.

The Situation in Gaza

In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind genocide allegations.

Despite periods of calm, doctors report that women and children are still perishing from inadequate care, owing to desperate lacks of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were inaccessible.

“Our facility has endured missile strikes hitting 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 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and extreme psychological pressure leading to problems during delivery.

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

“The truth of the matter is, every facility can be under attack now,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

Accountability Evaporates

For the over half a billion females living close to deadly warfare, there are scarce guarantees and even fewer war crimes prosecutions for those attacking childbirth services.

This void of justice has created a “atmosphere of lawlessness,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”

Additional Hotspots

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 inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.

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 preventable with routine care, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” notes a legal researcher.

“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has often been cited as an excuse.”