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Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were experiencing childbirth.

On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”

This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Combatants raided the hospital, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have described it as “an unspeakable atrocity,” and a prime example of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

Although world powers are signatories to the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are particularly at risk due to their dependence on locally available medical care.

An investigation of records 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 direct strikes on hospitals and delivery wards.

“These incidents do not represent inevitable outcomes of conflict. They constitute a pattern of reproductive violence.”

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

Women have been killed, prevented from accessing care, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 detained—sometimes while assisting births.

The Global Crisis in Maternal Health

These figures likely represent a grave undercount, as they only include incidents reported in news outlets. In many war-torn areas, information is scarce.

Last year, analysis showed that 50% of women who lost their lives in maternal circumstances were in a conflict area. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are wrecking hospitals and wards, posing a long-term threat 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 part of the basis for declaring certain actions a genocide.

Despite periods of calm, doctors report that women and children continue to die from a lack of proper treatment, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside 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 contested deliberately targeting maternity care or aiming to influence birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births forced underground and skyrocketing stress leading to problems during delivery.

“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The reality is, every facility can be under attack now,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

Accountability Evaporates

For the over half a billion females living close to deadly warfare, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.

This void of justice has led to a “culture of impunity,” explains a human rights lawyer. “Attacks on reproductive healthcare, 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 spiking dangerously, 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 damaged a maternity hospital, resulting in tragic loss of life.

In Myanmar, medical facilities have been bombed 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 shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births lacking professional help.

“When childbirth centers become intentional targets points toward a larger and alarming strategy: 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 may forfeit their immunity if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”