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A group of thirty mothers had taken refuge in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were actively in labor.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he explains. “They executed everybody inside the hospital. We who were able to escape, did so.”

This brutal attack stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Combatants stormed the facility, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the collapse in safety for civilians living amidst warfare in multiple global hotspots.

A Record of Violence Against Maternal Care

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 violence targeting health services. Women undergoing childbirth are exceptionally vulnerable due to their dependence 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 direct strikes on hospitals and delivery wards.

“These are not inevitable outcomes of conflict. They form a systematic assault on childbirth.”

The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where a vast number of pregnant women are trapped.

Women have been killed, blocked from reaching help, or forced to give birth in dangerous and unsanitary conditions. 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

These figures likely represent a substantial underreporting, as they are limited to incidents documented publicly. In many war-torn areas, reporting is limited.

Last year, it was reported that one in two mothers who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.

In addition to the loss of life, these attacks are destroying maternal and neonatal care facilities, jeopardizing the future to community survival.

Conditions within Gaza

In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as one reason behind 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 delivering babies amidst ruins because hospitals were out of reach.

“Direct shelling fired at 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. Accounts from embattled medical centers describe births occurring in shelters 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 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.”

A Culture of Impunity

For the more than 676 million women living near active conflicts, there are few safeguards and a stark lack of legal accountability for those targeting maternity care.

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, 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 increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is limited by a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, resulting in tragic loss of life.

In Myanmar, medical facilities have been bombed 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 destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births lacking professional help.

“The deliberate attack on maternity wards points toward a larger and alarming strategy: 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 may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”