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Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were in the midst of labor.

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 explains. “They were killing everyone inside the hospital. Those who could run, fled.”

This brutal attack stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen stormed the facility, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have labeled it “an act of unspeakable brutality,” and a stark illustration of the collapse in safety for civilians caught in conflict zones in several nations at war.

An Unprecedented Assault 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 witnessed an unprecedented spike of attacks on healthcare systems. Expectant mothers are particularly at risk due to their need for locally available medical care.

Research and compiled data uncover an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“This is not inevitable outcomes of conflict. They represent a systematic assault on childbirth.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of women bearing children are confined.

Women have been killed, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 kidnapped, and 101 taken into custody—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

These figures likely represent a grave undercount, as they capture solely incidents covered by the media. In many war-torn areas, reporting is limited.

Last year, analysis showed that half of all women who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.

Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, creating a grave danger 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.

Even after ceasefires, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals were out of reach.

“We’ve had rockets targeting 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 maternity and neonatal facilities have been struck and ruined in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure leading to birth complications.

“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” notes 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 within range of fighting, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.

This absence of consequences has created a “culture of impunity,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, may constitute acts of genocide by preventing births.”

Additional Hotspots

In El Fasher, the area lacked access to 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 lack of access from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, 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

Most maternal 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 devoid of emergency care.

“When childbirth centers become intentional targets points toward a larger and alarming strategy: the use of violence against hospitals as a tool for terror and to tear apart the social fabric,” notes 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.”