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Thirty women were huddled for safety 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, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”

This horrifying event stands as a particularly egregious examples in the ongoing war tearing the African nation apart. Combatants forced their way into the building, leaving dead more than 460 innocent people inside.

Rights organizations have described it as “a crime beyond words,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.

A Record of Violence On Childbirth Services

Despite every significant nation are signatories to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.

Research and compiled data show 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 targeted attacks against hospitals and delivery wards.

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

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of pregnant women are trapped.

Women have been killed, denied medical attention, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been murdered, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a substantial underreporting, as they are limited to incidents documented publicly. In many conflict zones, information is scarce.

Last year, findings indicated that half of all women who lost their lives in maternal circumstances resided in a war zone. This underscores a horrifying trend.

Apart from fatalities, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to community survival.

The Situation in Gaza

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

Even after ceasefires, doctors report that women and children continue to die from medical shortages, owing to desperate lacks of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.

“Our facility has endured missile strikes 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. Accounts from embattled medical centers describe births occurring in shelters and extreme psychological pressure leading to problems during delivery.

“The attacks on us are intentional,” 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 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.”

Accountability Evaporates

For the hundreds of millions of women living close to deadly warfare, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.

This lack of accountability has fostered a “culture of impunity,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute acts of genocide by destroying a group's future.”

Additional Hotspots

In El Fasher, the area had been cut off 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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, killing mothers, babies, and nurses.

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

A large proportion of mother deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births lacking professional help.

“The deliberate attack on maternity wards indicates a broader and more sinister pattern: the use of violence against hospitals 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 are not inviolable if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”