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Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. 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, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he states. “They executed everybody inside the hospital. We who were able to escape, did so.”

This appalling incident stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers forced their way into the building, reportedly killing more than 460 patients and their companions.

Rights organizations have described it as “an unspeakable atrocity,” and a prime example of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.

An Unprecedented Assault On Childbirth Services

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. Expectant mothers are highly exposed due to their need for locally available medical care.

An investigation of records reveal 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 direct strikes on hospitals and delivery wards.

“This is not standard wartime hazards. They represent a systematic assault on childbirth.”

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

Mothers have lost their lives, prevented from accessing care, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 taken hostage, and 101 taken into custody—sometimes during medical procedures.

A Worldwide Emergency for Mothers and Newborns

Statistics are thought to be a significant underestimate, as they only include incidents covered by the media. In many war-torn areas, information is scarce.

Last year, analysis showed that 50% of women who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to demographic stability.

Conditions within Gaza

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

Despite periods of calm, doctors report that women and children succumb from medical shortages, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were inaccessible.

“Direct shelling targeting 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 aiming to influence birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and skyrocketing stress leading to maternal health issues.

“Russia is targeting us deliberately,” claims 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,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

Accountability Evaporates

For the hundreds of millions of women living close to deadly warfare, there are few safeguards and even fewer war crimes prosecutions for those attacking childbirth services.

This void of justice has created a “environment where anything goes,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, 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 struck a baby care unit, causing fatalities among patients and staff.

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

The Collapse of Safe Childbirth

The majority of childbirth fatalities are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births lacking professional help.

“The deliberate attack on maternity wards speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to break societal cohesion,” notes a legal researcher.

“Hospitals are not completely safe 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.”