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Dozens of women were seeking shelter in a childbirth facility in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were experiencing childbirth.

On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he explains. “They executed everybody inside the hospital. Survival meant running for your life.”

This horrifying event stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen forced their way into the building, reportedly killing more than 460 patients and their companions.

Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.

A Record of Violence Against Maternal Care

Despite every significant nation have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of violence targeting health services. Women undergoing childbirth are highly exposed due to their reliance 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 form a deliberate strategy of violence against reproduction.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where a vast number of pregnant women are trapped.

Deaths have occurred, prevented from accessing care, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been murdered, 15 abducted, and 101 arrested—sometimes during medical procedures.

The Global Crisis for Mothers and Newborns

Statistics are thought to be a substantial underreporting, as they are limited to incidents documented publicly. In many conflict zones, communications are sparse.

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

Apart from fatalities, these attacks are obliterating critical infrastructure for mothers and babies, posing a long-term threat to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the devastating effect 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. Agencies have reported women giving birth in rubble because hospitals could not be reached.

“Our facility has endured missile strikes targeting the wards, operating rooms, and maternity wards,” explains 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 childbirth centers have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to problems during delivery.

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

“In fact, every facility faces the threat of assault,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

Accountability Evaporates

For the over half a billion females living close to deadly warfare, there are minimal protections and even fewer war crimes prosecutions for those assaulting reproductive health.

This lack of accountability has led to a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute acts of genocide by destroying a group's future.”

Additional Hotspots

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 restricted due to 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, hospitals have come under fire 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 preventable with routine care, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted points toward a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” says a legal researcher.

“Hospitals are not completely safe 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 increasingly been used as a justification.”