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Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were in the midst of labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he states. “They executed everybody inside the hospital. We who were able to escape, did so.”

This appalling incident stands as one of the most shocking examples in the protracted internal conflict tearing the African nation apart. Combatants stormed the facility, leaving dead more than 460 patients and their companions.

Rights organizations have described it as “an unspeakable atrocity,” and a prime example of the deteriorating protection for civilians trapped in war-torn areas in several nations at war.

A Record of Violence Against Maternal Care

While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are particularly at risk due to their reliance on locally available medical care.

Research and compiled data show an shocking trend: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These are not inevitable outcomes of conflict. They constitute a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of expectant mothers are stranded.

Women have been killed, prevented from accessing care, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been murdered, 15 kidnapped, and 101 taken into custody—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

The numbers are probably a substantial underreporting, as they only include incidents reported in news outlets. In many war-torn areas, communications are sparse.

Last year, analysis showed that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.

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

Conditions within Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as one reason behind declaring certain actions a genocide.

Following truces, doctors report that women and children are still perishing from inadequate care, owing to severe deficits 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 targeting the wards, operating rooms, and maternity wards,” states 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 struck and ruined in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to problems during delivery.

“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected 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 can strike a hospital.”

Accountability Evaporates

For the more than 676 million women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those targeting maternity care.

This void of justice has created a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by hindering reproduction.”

Other Conflict Zones

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 scarce because of a communication blackout 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 faced detention, death, or harm 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 shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted indicates a broader and more sinister pattern: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” notes a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”