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A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were in the midst of labor.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he recounts. “A massacre was taking place inside the hospital. Those who could run, fled.”

This appalling incident stands as a particularly egregious examples in the protracted internal conflict tearing the African nation apart. Militiamen raided the hospital, reportedly killing more than 460 innocent people inside.

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

An Unprecedented Assault On Childbirth Services

While all major powers are signatories to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.

An investigation of records uncover an alarming level of violence: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These are not standard wartime hazards. They represent a systematic assault on childbirth.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where hundreds of thousands of expectant mothers are stranded.

Mothers have lost their lives, blocked from reaching help, or compelled to deliver in deplorable situations. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 detained—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

The numbers are probably a grave undercount, as they capture solely 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 resided in a war zone. This underscores a catastrophic reality.

Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, jeopardizing the future to demographic stability.

Conditions within Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as part of the basis for 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. UN officials have relayed women giving birth in rubble 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 denied deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to problems during delivery.

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

“The reality is, every facility faces the threat of assault,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”

A Culture of Impunity

For the more than 676 million women living within range of fighting, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.

This lack of accountability has led to a “environment where anything goes,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”

Additional Hotspots

In El Fasher, the area lacked access to 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 restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.

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 Collapse of Safe Childbirth

The majority of childbirth fatalities are preventable with routine care, but war collapses medical infrastructure. Rights groups note that terror is compelling 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 violence against hospitals as a means of intimidation and to break societal cohesion,” 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 ‘harmful to the enemy’, which has now become a standard defence.”