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Dozens of women were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were actively in labor.

Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he states. “They executed everybody inside the hospital. Those who could run, fled.”

This horrifying event stands as a particularly egregious examples in the two-year civil war tearing the North African nation apart. Armed soldiers stormed the facility, leaving dead more than 460 patients and their companions.

Rights organizations have described it as “an act of unspeakable brutality,” and a stark illustration of the collapse in safety for civilians trapped in war-torn areas in multiple global hotspots.

A Record of Violence Against Maternal Care

While all major powers have signed the international laws of war, which require them to safeguard civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.

Data analysis and investigations uncover an shocking trend: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These are not natural consequences of war. They represent a systematic assault on childbirth.”

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

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 slain, 15 abducted, and 101 taken into custody—sometimes in the act of delivering babies.

The Global Crisis in Maternal Health

These figures likely represent a significant underestimate, as they are limited to incidents covered by the media. In many war-torn areas, information is scarce.

Last year, findings indicated that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a horrifying trend.

In addition to the loss of life, these attacks are wrecking hospitals and wards, jeopardizing the future to demographic stability.

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 genocide allegations.

Despite periods of calm, doctors report that women and children are still perishing from medical shortages, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals were out of reach.

“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or aiming to influence birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to birth complications.

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

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

A Culture of Impunity

For the more than 676 million women 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 led to a “culture of impunity,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”

Other Conflict Zones

In El Fasher, the area was isolated 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 restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, resulting in tragic loss of life.

In Myanmar, clinics have been attacked 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 preventable with routine care, 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 devoid of emergency care.

“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: 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.”