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Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were in the midst of labor.

Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he recounts. “They were killing everyone 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. Militiamen raided the hospital, reportedly killing more than 460 individuals receiving care and their families.

Rights organizations have labeled it “an act of unspeakable brutality,” and a prime example of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.

A Record of Violence Against Maternal Care

While all major powers have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.

Research and compiled data show 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 pattern of reproductive violence.”

The majority of these incidents have happened 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 perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 taken hostage, and 101 taken into custody—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a significant underestimate, as they capture solely incidents documented publicly. In many areas of fighting, reporting is limited.

Last year, findings indicated that half of all women who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.

In addition to the loss of life, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as one reason behind declaring certain actions a genocide.

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

“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has contested 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 struck and ruined in Ukraine. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to maternal health issues.

“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“In fact, every facility is now a potential target,” notes 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 within range of fighting, there are scarce guarantees and even fewer war crimes prosecutions for those attacking childbirth services.

This void of justice has led to a “environment where anything goes,” explains 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 rising sharply, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is limited by 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, 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 End of Safe Deliveries

Most maternal deaths are avoidable with standard medicine, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“When childbirth centers become intentional targets indicates a broader and more sinister pattern: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” notes a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”