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A group of thirty mothers were seeking shelter in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. 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, became one of the few known survivors. “There were cries of women and children,” he states. “They were killing everyone inside the hospital. Those who could run, fled.”

This brutal attack stands as among the worst examples in the ongoing war tearing the North African nation apart. Combatants stormed the facility, leaving dead more than 460 innocent people inside.

Rights organizations have called it “a crime beyond words,” and a prime example of the collapse in safety for civilians caught in conflict zones in several nations at war.

An Unprecedented Assault Against Maternal Care

While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are exceptionally vulnerable due to their reliance on locally available medical care.

An investigation of records uncover an alarming level of violence: 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 are not natural consequences of war. They form a deliberate strategy of violence against reproduction.”

The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.

Women have been killed, prevented from accessing care, or compelled to deliver in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 kidnapped, and 101 taken into custody—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a substantial underreporting, as they only include incidents documented publicly. In many areas of fighting, reporting is limited.

Last year, it was reported that one in two mothers who died during pregnancy or childbirth resided in a war zone. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are obliterating hospitals and wards, creating a grave danger 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 accusations of genocidal acts.

Despite periods of calm, doctors report that women and children are still perishing from medical shortages, owing to critical shortages of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals could not be reached.

“We’ve had rockets 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 seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been struck and ruined in Ukraine. Reports from frontline hospitals describe births forced underground and skyrocketing stress leading to birth complications.

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

“In fact, every facility is now a potential target,” notes a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”

A Culture of Impunity

For the more than 676 million women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those targeting maternity care.

This lack of accountability has led to a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as 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 increasing drastically, 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 damaged a maternity hospital, resulting in tragic loss of life.

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 End of Safe Deliveries

A large proportion of mother deaths are preventable with routine care, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births without skilled assistance.

“The deliberate attack on maternity wards indicates a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” notes 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 ‘harmful to the enemy’, which has often been cited as an excuse.”