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A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were experiencing childbirth.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he states. “A massacre was taking place inside the hospital. We who were able to escape, did so.”

This brutal attack stands as a particularly egregious 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 called it “a crime beyond words,” and a clear case of the vanishing safeguards for civilians caught in conflict zones 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 international laws of war, which commit them to defending civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Women undergoing childbirth are particularly at risk due to their dependence on locally available medical care.

Research and compiled data uncover an unprecedented scale of attacks: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These incidents do not represent natural consequences of war. They form a systematic assault on childbirth.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where countless of pregnant women are trapped.

Women have been killed, blocked from reaching help, or forced to give birth in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 taken into custody—sometimes during medical procedures.

The Global Crisis in Maternal Health

These figures likely represent a substantial underreporting, as they are limited to incidents reported in news outlets. In many conflict zones, information is scarce.

Last year, it was reported that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.

Apart from fatalities, these attacks are destroying maternal and neonatal care facilities, creating a grave danger 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 medical shortages, owing to severe deficits of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals could not be reached.

“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or seeking to affect birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and extreme psychological pressure leading to problems during delivery.

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

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

Accountability Evaporates

For the more than 676 million women living close to deadly warfare, there are few safeguards and rare trials for atrocities for those targeting maternity care.

This lack of accountability has created a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute acts of genocide by destroying a group's future.”

Other Conflict Zones

In El Fasher, the area was isolated from 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 scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.

In Myanmar, hospitals have come under fire 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 averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births devoid of emergency care.

“The deliberate attack on maternity wards points toward a broader and more sinister pattern: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” says a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”