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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 actively in labor.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he states. “They were killing everyone inside the hospital. Those who could run, fled.”

This appalling incident stands as a particularly egregious examples in the two-year civil war tearing the African nation apart. Armed soldiers forced their way into the building, leaving dead more than 460 patients and their companions.

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

A Record of Violence On Childbirth Services

Although world powers have signed the Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Women undergoing childbirth are particularly at risk due to their reliance on locally available medical care.

Data analysis and investigations uncover an shocking trend: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These incidents do not represent inevitable outcomes of conflict. They represent a systematic assault on childbirth.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where countless of pregnant women are trapped.

Deaths have occurred, 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 abducted, and 101 detained—sometimes in the act of delivering babies.

The Global Crisis for Mothers and Newborns

These figures likely represent a grave undercount, as they capture solely incidents reported in news outlets. In many conflict zones, communications are sparse.

Last year, it was reported that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a catastrophic reality.

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 the right to maternal care has been cited by a UN commission as a factor in genocide allegations.

Following truces, doctors report that women and children are still perishing from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were inaccessible.

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

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to problems during delivery.

“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“The truth of the matter is, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”

Accountability Evaporates

For the hundreds of millions of women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those attacking childbirth services.

This absence of consequences has created a “environment where anything goes,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially acts of genocide by preventing births.”

Additional Hotspots

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 inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, 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

Most maternal deaths are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births lacking professional help.

“When childbirth centers become intentional targets indicates a larger and alarming strategy: the use of attacks on medical facilities as a weapon to spread fear and to break societal cohesion,” says a legal researcher.

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