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A group of thirty mothers were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he states. “A massacre was taking place inside the hospital. Survival meant running for your life.”

This brutal attack stands as among the worst examples in the ongoing war tearing the North African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have called it “a crime beyond words,” and a prime example of the deteriorating protection for civilians living amidst warfare in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

Although world powers are signatories to the Geneva conventions, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are highly exposed due to their need for locally available medical care.

Data analysis and investigations uncover an unprecedented scale of attacks: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“This is not natural consequences of war. They represent a pattern of reproductive violence.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.

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 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 taken into custody—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a significant underestimate, as they only include incidents reported in news outlets. In many war-torn areas, reporting is limited.

Last year, analysis showed that one in two mothers who died during pregnancy or childbirth lived amidst hostilities. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, jeopardizing the future to demographic stability.

The Situation in Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for declaring certain actions a genocide.

Despite periods of calm, doctors report that women and children are still perishing from a lack of proper treatment, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were inaccessible.

“Our facility has endured missile strikes 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 childbirth centers have been struck and ruined in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to birth complications.

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

“In fact, every facility is now a potential target,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

Accountability Evaporates

For the more than 676 million women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.

This absence of consequences has created a “culture of impunity,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by destroying a group's future.”

Other Conflict Zones

In El Fasher, the area had been cut off 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 inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.

In Myanmar, medical facilities have been bombed and dozens of midwives and patients have suffered violence over the past two years of civil war.

The End of Safe Deliveries

A large proportion of mother deaths are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births without skilled assistance.

“The deliberate attack on maternity wards points toward a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to tear apart the social fabric,” says a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”