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Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. 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, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he recounts. “They were killing everyone inside the hospital. Those who could run, fled.”

This brutal attack stands as one of the most shocking examples in the ongoing 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 act of unspeakable brutality,” and a stark illustration of the vanishing safeguards for civilians trapped in war-torn areas in multiple global hotspots.

A Record of Violence On Childbirth Services

While all major powers are signatories to the international laws of war, which commit them to defending civilians, the past year has seen a record number of assaults against medical infrastructure. 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 violent acts against 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 form a systematic assault on childbirth.”

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

Deaths have occurred, blocked from reaching help, 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 in the act of delivering babies.

A Worldwide Emergency in Maternal Health

Statistics are thought to be a grave undercount, as they are limited to incidents reported in news outlets. In many conflict zones, reporting is limited.

Last year, findings indicated that one in two mothers who perished while pregnant or giving birth lived amidst hostilities. This underscores a devastating pattern.

Beyond killing women and staff, these attacks are destroying hospitals and wards, jeopardizing the future to societal repopulation and recovery.

The Situation in Gaza

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

Following truces, doctors report that women and children continue to die from inadequate care, owing to critical shortages of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals were inaccessible.

“Direct shelling fired at the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has rejected 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 taking place in basements and skyrocketing stress leading to problems during delivery.

“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“The reality is, 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.”

A Culture of Impunity

For the hundreds of millions of women living close to deadly warfare, there are scarce guarantees and a stark lack of legal accountability for those attacking childbirth services.

This void of justice has fostered 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.”

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 limited by 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, medical facilities have been bombed 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

A large proportion of mother deaths are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that terror is compelling 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 destroy community bonds,” observes 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 ‘militarily advantageous’, which has now become a standard defence.”