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Dozens of women had taken refuge 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, managed to survive the ordeal. “I heard the screams of women and children,” he states. “A massacre was taking place inside the hospital. Those who could run, fled.”

This horrifying event stands as one of the most shocking examples in the protracted internal conflict tearing the North African nation apart. Militiamen stormed the facility, allegedly slaughtering more than 460 individuals receiving care and their families.

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 On Childbirth Services

While all major powers have agreed to the Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Expectant mothers are particularly at risk due to their need for locally available medical care.

An investigation of records 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 targeted attacks against hospitals and delivery wards.

“This is not natural consequences of war. They form a deliberate strategy of violence against reproduction.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of expectant mothers are stranded.

Deaths have occurred, prevented from accessing care, or made to have their babies in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 taken hostage, and 101 detained—sometimes in the act of delivering babies.

The Global Crisis for Mothers and Newborns

Statistics are thought to be a significant underestimate, as they only include incidents covered by the media. In many areas of fighting, reporting is limited.

Last year, findings indicated that half of all women 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 maternal and neonatal care facilities, posing a long-term threat to demographic stability.

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 accusations of genocidal acts.

Following truces, doctors report that women and children succumb 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 could not be reached.

“Direct shelling hitting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or trying to alter birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births taking place in basements and skyrocketing stress leading to maternal health issues.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” comments 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 near active conflicts, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.

This absence of consequences has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”

Additional Hotspots

In El Fasher, the area lacked access to 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 hit a neonatal ward, causing fatalities among patients and staff.

In Myanmar, medical facilities have been bombed and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.

The End of Safe Deliveries

Most maternal deaths are preventable with routine care, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.

“When childbirth centers become intentional targets indicates a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” says a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”