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Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were experiencing childbirth.

On duty during that fateful night, 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 explains. “A massacre was taking place inside the hospital. We who were able to escape, did so.”

This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers forced their way into the building, leaving dead more than 460 patients and their companions.

Rights organizations have called it “an unspeakable atrocity,” and a stark illustration of the collapse in safety for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault On Childbirth Services

While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Mothers in labor are highly exposed due to their dependence on locally available medical care.

Research and compiled data 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 direct strikes on hospitals and delivery wards.

“These incidents do not represent standard wartime hazards. They represent a systematic assault on childbirth.”

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where a vast number of women bearing children are confined.

Mothers have lost their lives, blocked from reaching help, or made to have their babies in deplorable situations. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 detained—sometimes during medical procedures.

The Global Crisis for Mothers and Newborns

The numbers are probably a substantial underreporting, as they capture solely incidents reported in news outlets. In many war-torn areas, communications are sparse.

Last year, it was reported that one in two mothers who died during pregnancy or childbirth lived amidst hostilities. This underscores a horrifying trend.

In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat to demographic stability.

Conditions within Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.

Even after ceasefires, doctors report that women and children continue to die from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Accounts describe women having children by the roadside 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 denied deliberately targeting maternity care or aiming to influence birthrates.

The Crisis in Ukraine

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 taking place in basements and skyrocketing stress leading to maternal health issues.

“Russia is targeting us deliberately,” 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 is now a potential target,” 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 hundreds of millions of women living near active conflicts, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.

This absence of consequences has fostered a “culture of impunity,” explains a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, may constitute 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 scarce because of a lack of access from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, causing fatalities among patients and staff.

In Myanmar, medical facilities have been bombed and dozens of midwives and patients have faced detention, death, or harm 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.

“If maternity hospitals are being deliberately targeted 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,” 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 ‘militarily advantageous’, which has now become a standard defence.”