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Thirty women were seeking shelter in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were experiencing childbirth.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he states. “A massacre was taking place inside the hospital. Survival meant running for your life.”

This appalling incident stands as a particularly egregious examples in the ongoing war tearing the North African nation apart. Militiamen forced their way into the building, reportedly killing more than 460 patients and their companions.

Rights organizations have described it as “an unspeakable atrocity,” and a stark illustration of the collapse in safety for civilians living amidst warfare in several nations at war.

A Record of Violence On Childbirth Services

While all major powers have signed the Geneva conventions, which obligate them to protect civilians, the past year has seen a record number of violence targeting health services. Expectant mothers are highly exposed due to their dependence on locally available medical care.

Research and compiled data reveal an unprecedented scale of attacks: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“This is not natural consequences of war. They form a systematic assault on childbirth.”

The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of expectant mothers are stranded.

Deaths have occurred, prevented from accessing care, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 detained—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a substantial underreporting, as they only include incidents covered by the media. In many war-torn areas, reporting is limited.

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

Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, creating a grave danger 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 one reason behind genocide allegations.

Even after ceasefires, doctors report that women and children are still perishing from inadequate care, owing to critical shortages of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals could not be reached.

“Our facility has endured missile strikes hitting 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 struck and ruined in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to maternal health issues.

“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“The truth of the matter is, every facility faces the threat of assault,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

A Culture of Impunity

For the more than 676 million women living within range of fighting, there are few safeguards and even fewer war crimes prosecutions for those targeting maternity care.

This lack of accountability has created a “environment where anything goes,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, 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 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, causing fatalities among patients and staff.

In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.

The End of Safe Deliveries

Most maternal deaths are avoidable with standard medicine, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births lacking professional help.

“The deliberate attack on maternity wards speaks to a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to break societal cohesion,” observes 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 ‘militarily advantageous’, which has often been cited as an excuse.”