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Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were experiencing childbirth.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he recounts. “They executed everybody inside the hospital. Those who could run, fled.”

This brutal attack stands as a particularly egregious examples in the protracted internal conflict tearing the African nation apart. Combatants forced their way into the building, allegedly slaughtering more than 460 individuals receiving care and their families.

Rights organizations have labeled it “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.

An Unprecedented Assault On Childbirth Services

While all major powers have signed the international laws of war, which require them to safeguard civilians, the past year has experienced a historic high of assaults against medical infrastructure. Mothers in labor are particularly at risk due to their dependence on locally available medical care.

Research and compiled data show 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.

“These incidents do not represent standard wartime hazards. They constitute a deliberate strategy of violence against reproduction.”

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

Women have been killed, denied medical attention, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 kidnapped, and 101 taken into custody—sometimes during medical procedures.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a grave undercount, as they only include incidents reported in news outlets. In many conflict zones, communications are sparse.

Last year, findings indicated that 50% of women who died during pregnancy or childbirth resided in a war zone. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are destroying maternal and neonatal care facilities, jeopardizing the future to demographic stability.

The Situation in Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.

Following truces, doctors report that women and children succumb from medical shortages, owing to critical shortages of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals could not be reached.

“We’ve had rockets fired at 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 trying to alter birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births forced underground and extreme psychological pressure 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 reality is, every facility can be under attack now,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”

A Culture of Impunity

For the hundreds of millions of women living near active conflicts, there are scarce guarantees and even fewer war crimes prosecutions for those targeting maternity care.

This absence of consequences has fostered a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, are potentially acts of genocide by hindering reproduction.”

Additional Hotspots

In El Fasher, the area had been cut off from humanitarian aid long before the hospital attack, with malnutrition rising sharply, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is limited by a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, resulting in tragic loss of life.

In Myanmar, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.

The Collapse of Safe Childbirth

Most maternal deaths are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted speaks to a broader and more sinister pattern: the use of violence against hospitals as a weapon to spread fear and to tear apart the social fabric,” 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 ‘harmful to the enemy’, which has increasingly been used as a justification.”