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A group of thirty mothers were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were in the midst of labor.

On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he explains. “A massacre was taking place inside the hospital. We who were able to escape, did so.”

This brutal attack stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Militiamen raided the hospital, reportedly killing more than 460 individuals receiving care and their families.

Rights organizations have called it “an unspeakable atrocity,” and a prime example of the deteriorating protection for civilians living amidst warfare in several nations at war.

An Unprecedented Assault Against Maternal Care

Although world powers have signed 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 alarming level of violence: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.

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

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.

Deaths have occurred, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 taken into custody—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a grave undercount, as they capture solely incidents covered by the media. In many conflict zones, reporting is limited.

Last year, it was reported that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a devastating pattern.

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

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 are still perishing from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside because hospitals could not be reached.

“Our facility has endured missile strikes fired at the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to birth complications.

“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

Accountability Evaporates

For the over half a billion females living within range of fighting, there are few safeguards and even fewer war crimes prosecutions for those targeting maternity care.

This lack of accountability has led to a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by preventing births.”

Additional Hotspots

In El Fasher, the area had been cut off from 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 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 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 destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“If maternity hospitals are being deliberately targeted indicates a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to break societal cohesion,” says a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘harmful to the enemy’, which has increasingly been used as a justification.”