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Dozens of women had taken refuge in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were actively in labor.

On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he recounts. “They were killing everyone inside the hospital. Survival meant running for your life.”

This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Combatants stormed the facility, leaving dead more than 460 patients and their companions.

Rights organizations have labeled it “a crime beyond words,” and a clear case of the vanishing safeguards for civilians trapped in war-torn areas in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

Despite every significant nation are signatories to the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are highly exposed due to their need for locally available medical care.

Research and compiled data uncover an unprecedented scale of attacks: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“This is not inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”

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

Mothers have lost their lives, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been murdered, 15 kidnapped, and 101 taken into custody—sometimes while assisting births.

The Global Crisis for Mothers and Newborns

Statistics are thought to be a grave undercount, as they are limited to incidents reported in news outlets. In many war-torn areas, communications are sparse.

Last year, analysis showed that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are wrecking hospitals and wards, posing a long-term threat to community survival.

Conditions within Gaza

In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as one reason behind genocide allegations.

Despite periods of calm, doctors report that women and children succumb from inadequate care, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were out of reach.

“Direct shelling hitting 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 seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to maternal health issues.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility can be under attack now,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”

Accountability Evaporates

For the over half a billion females 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 fostered a “culture of impunity,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, can be understood as acts of genocide by destroying a group's future.”

Other Conflict Zones

In El Fasher, the area was isolated from humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is scarce because of 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 End of Safe Deliveries

Most maternal deaths are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births devoid of emergency care.

“If maternity hospitals are being deliberately targeted points toward a larger and alarming strategy: the use of attacks on medical facilities as a weapon to spread fear 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 ‘militarily advantageous’, which has often been cited as an excuse.”