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Dozens of women were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were in the midst of labor.

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 recounts. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This appalling incident stands as among the worst examples in the ongoing war tearing the North African nation apart. Militiamen stormed the facility, reportedly killing more than 460 innocent people inside.

Rights organizations have labeled it “an unspeakable atrocity,” and a clear case of the collapse in safety for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

While all major powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of violence targeting health services. Mothers in labor are particularly at risk due to their reliance on locally available medical care.

Data analysis and investigations 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 targeted attacks against hospitals and delivery wards.

“This is not natural consequences of war. They represent 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.

Women have been killed, blocked from reaching help, or compelled to deliver in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 taken hostage, and 101 arrested—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

Statistics are thought to be a substantial underreporting, as they only include incidents covered by the media. In many war-torn areas, reporting is limited.

Last year, analysis showed that one in two mothers who died during pregnancy or childbirth were in a conflict area. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, posing a long-term threat to community survival.

Conditions within 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 succumb from inadequate care, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were inaccessible.

“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 denied deliberately targeting maternity care or aiming to influence birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to birth complications.

“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The truth of the matter is, every facility can be under attack now,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

A Culture of Impunity

For the over half a billion females living close to deadly warfare, there are few safeguards and rare trials for atrocities for those assaulting reproductive health.

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

Other Conflict Zones

In El Fasher, the area lacked access to 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 lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, causing fatalities among patients and staff.

In Myanmar, hospitals have come under fire and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.

The End of Safe Deliveries

Most maternal deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births without skilled assistance.

“If maternity hospitals are being deliberately targeted indicates a broader and more sinister pattern: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” notes 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.”