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Dozens of women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were in the midst of labor.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “There were cries of women and children,” he recounts. “They executed everybody inside the hospital. We who were able to escape, did so.”

This horrifying event stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Armed soldiers raided the hospital, leaving dead 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 Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence Against Maternal Care

Despite every significant nation have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has seen a record number of attacks on healthcare systems. Expectant mothers are highly exposed due to their dependence on locally available medical care.

An investigation of records uncover an unprecedented scale of attacks: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“This is not natural consequences of war. They form a deliberate strategy of violence against reproduction.”

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.

Deaths have occurred, denied medical attention, or made to have their babies in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been murdered, 15 taken hostage, and 101 taken into custody—sometimes in the act of delivering babies.

The Global Crisis for Mothers and Newborns

The numbers are probably a significant underestimate, as they capture solely incidents covered by the media. In many conflict zones, information is scarce.

Last year, findings indicated that 50% of women who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are destroying hospitals and wards, jeopardizing the future to societal repopulation and recovery.

The Situation in Gaza

In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as one reason behind genocide allegations.

Despite periods of calm, doctors report that women and children are still perishing from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were inaccessible.

“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 aiming to influence birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to birth complications.

“The attacks on us are intentional,” 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 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.”

Accountability Evaporates

For the over half a billion females living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.

This void of justice has led to a “environment where anything goes,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as 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 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 damaged a maternity hospital, killing mothers, babies, and nurses.

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 End of Safe Deliveries

The majority of childbirth fatalities are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births without skilled assistance.

“If maternity hospitals are being deliberately targeted speaks to a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” says a legal researcher.

“Safeguards are not guaranteed 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 often been cited as an excuse.”