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Dozens of 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, managed to survive the ordeal. “There were cries of women and children,” he recounts. “A massacre was taking place inside the hospital. Those who could run, fled.”

This horrifying event stands as among the worst examples in the two-year civil war tearing the North African nation apart. Armed soldiers forced their way into the building, allegedly slaughtering more than 460 individuals receiving care and their families.

Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.

An Unprecedented Assault On Childbirth Services

While all major powers have signed the Geneva conventions, which commit them to defending civilians, the past year has witnessed an unprecedented spike of assaults against medical infrastructure. Expectant mothers are exceptionally vulnerable due to their reliance on locally available medical care.

An investigation of records uncover an alarming level of violence: 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 represent a pattern of reproductive violence.”

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

Deaths have occurred, prevented from accessing care, or compelled to deliver in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 taken hostage, and 101 taken into custody—sometimes while assisting births.

The Global Crisis for Mothers and Newborns

Statistics are thought to be a grave undercount, as they capture solely incidents covered by the media. In many areas of fighting, information is scarce.

Last year, it was reported that one in two mothers who lost their lives in maternal circumstances resided in a war zone. This underscores a catastrophic reality.

Apart from fatalities, these attacks are obliterating critical infrastructure for mothers and babies, jeopardizing the future to societal repopulation and recovery.

The Situation in Gaza

In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as a factor in genocide allegations.

Following truces, doctors report that women and children are still perishing from medical shortages, owing to critical shortages of medicine and equipment. Agencies have reported women having children by the roadside 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 denied deliberately targeting maternity care or seeking to affect birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births taking place in basements and extreme psychological pressure leading to maternal health issues.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The truth of the matter is, every facility is now a potential target,” states 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 more than 676 million women 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 fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, are potentially 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 spiking dangerously, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is scarce because of a communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, 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

The majority of childbirth fatalities are preventable with routine care, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births without skilled assistance.

“When childbirth centers become intentional targets points toward a wider and more disturbing trend: the use of attacks on medical facilities as a means of intimidation 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 increasingly been used as a justification.”