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Dozens of women had taken refuge in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were actively in labor.

Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “There were cries of women and children,” he explains. “They were killing everyone inside the hospital. Those who could run, fled.”

This appalling incident stands as among the worst examples in the two-year civil war tearing the North African nation apart. Combatants raided the hospital, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have called it “an unspeakable atrocity,” and a prime example of the vanishing safeguards for civilians living amidst warfare in multiple global hotspots.

An Unprecedented Assault On Childbirth Services

While all major powers are signatories to the Geneva conventions, which commit them to defending civilians, the past year has experienced a historic high of assaults against medical infrastructure. Mothers in labor are highly exposed due to their reliance on locally available medical care.

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

“These incidents do not represent inevitable outcomes of conflict. They form a systematic assault on childbirth.”

The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of expectant mothers are stranded.

Deaths have occurred, prevented from accessing care, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been murdered, 15 kidnapped, and 101 detained—sometimes while assisting births.

The Global Crisis in Maternal Health

Statistics are thought to be a substantial underreporting, as they are limited to incidents covered by the media. In many areas of fighting, information is scarce.

Last year, analysis showed that one in two mothers who perished while pregnant or giving birth resided in a war zone. This underscores a devastating pattern.

Beyond killing women and staff, these attacks are obliterating hospitals and wards, posing a long-term threat to demographic stability.

The Situation in Gaza

In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as part of the basis for genocide allegations.

Even after ceasefires, doctors report that women and children succumb from medical shortages, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.

“Our facility has endured missile strikes fired at 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 forced underground and skyrocketing stress leading to birth complications.

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

“The truth of the matter is, every facility is now a potential target,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

A Culture of Impunity

For the over half a billion females living within range of fighting, there are scarce guarantees and even fewer war crimes prosecutions for those attacking childbirth services.

This absence of consequences has led to a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute acts of genocide by hindering reproduction.”

Other Conflict Zones

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

In Myanmar, hospitals have come under fire and dozens of midwives and patients have suffered violence over the past two years of civil war.

The Collapse of Safe Childbirth

The majority of childbirth fatalities are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.

“If maternity hospitals are being deliberately targeted points toward a wider and more disturbing trend: the use of attacks on medical facilities as a tool for terror and to tear apart the social fabric,” says a legal researcher.

“There is no absolute protection 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 now become a standard defence.”